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I have been tasked with talking about managing and responding to Microaggressions. Um and I've got to say, um, this talk I found as terrifying as the the previous unconscious bias, uh, that I talked about because the real difficulty is and those of you who watched the diversity inclusion, um uh, talks that we did last week. The reality is, is that there are, um if you look at my demographic, actually, I have many more of the factors that provide me with the privilege and power side of things than I do that Leave me with the underrepresented or groups that are more prone to microaggressions. So the reality of this talk is I'm giving a talk about microaggressions, and whilst I've been exposed them, the reality is probably done more. My progressions trouble people than I've actually received myself, which is a difficult thing to admit, but also to see, So it's really important, um, to have a bit of self reflection. But also I'm very aware that within the group that I'm talking to and within you guys, they will be much more experience and exposure. Um, and everybody will have had different experiences and because of that. It's incredibly important that we all share and we all chat and it becomes very open environment, as opposed to me just sitting there, lecturing here because, as I say, I think there are a lot of things that I haven't experienced or don't have an understanding of, Um, and certainly don't have a lived experience of, um that if other people want to share, would be would be really, really great. Really powerful. So when I was an S t three, um, my consultant was talking to another. A couple of other surgeons, uh, with, like me in hearing they knew I was there. Who said this about the fact that after I finished working with them, uh, as to who the next register I was going to be, Um, And as you can imagine, uh, I was a bit sort of, uh and then I just accepted it. Uh, but I thought on it, and it's definitely stayed with me. Which, which means that that was, um that was something that happened, and I I was in some way. I was affected by it. So what are microaggressions? So can I have some volunteers of people just speaking. So what What are microaggressions? I can't tell anybody's name so I could pick the ones I can. I knew were already there early, but it seems a bit mean. People are later. What? Our micro fashions. It's like an inappropriate behavior. Yep. Uh, with, uh, with possible, like, uh, unacceptable words, um, which might undermine the other side of the conversation. Something like this. Yeah. And who is that? They These microaggressions are being perpetrated again. So who is it who are receiving again? Our microaggression? Because there are different than they are different than people. Uh, you know, that sort of, um, sniping or being mean for a variety of reasons. They're quite specific. Aren't they? Sit? Does anyone know? So it tends to be to what was considered marginalized or sort of nonstandard. Groups are tend to be the people who are on the receiving end of microaggressions. So there's been a couple of sort of official statements is what Microaggressions are. Um Chester Price from Harvard in 19 seventies actually coined the phrase microaggression and, um, in that particular way that they phrased it. He was talking about, um uh, microaggressions perpetrated by white people against black people. But in 1973 that was changed to include some gender microaggressions, and then that's gradually changed to increase. Um, two different, uh, areas of as I say, um, marginalized or non mainstream communities. So So these are brief exchanges that send, um, uh, negative or, um or sort of, uh, any sort of message that that makes a a member of of a model. Right. So we've got small group one. So who was in small Group one? Vicky? Uh, yeah. Brilliant. OK, so, guys, um come on. Tell me what What What were you taking this? So I'm just about everybody else. I'm just gonna say so. Um, I hope those who haven't read it. You're in ST six. New hospital team seems friendly. There's lots of joking going around in the trauma meeting. You're afraid to the essay of your new consult? You've done a difficult subject, uh, fracture with federal. Now, directors brought up and the X rays are reviewed. Um, mister B turns to you and said you did that operation well for a girl. The other registrars and consultants laugh. The meeting finishes and you had to clinic one of the F two s who feels so female says, Is that normal? And you shrug, saying they were just joking. Okay, go for it. And so we basically felt that it should be You could just ignore it. But actually, even if you didn't feel offended by it, obviously that FT felt something about it and for future, that work in the department, it's probably something that should be addressed. Um, majority of us didn't feel that we would want to address it directly with the person that had said it. And that would probably go to either our clinical supervisor or a s dependent, or someone in the consultant within the department that we felt comfortable talking to about it and to see if they could maybe have a conversation with them about it and try and work out where to go going forward because they might not have even realized that they said anything particularly offensive or that anyone had taken offense to it. They might feel like they're being funny. Yeah, and they might be horrified that someone was upset by it. And so why wouldn't you go directly to that consultant to to say, um I personally wouldn't feel confident enough. It depends. I think it depends on the relationship you have with them. Um, if you as some people may feel comfortable, I think that I don't think I'd want I think I find that conversation quite uncomfortable. Um, and also it's talking to someone else outside of the situation. Sometimes that's quite nice, and it makes it a bit more because you could have a little conversation with that person, and then they might say it again. And there's nothing kind of necessarily official that's been brought up about it as well. So at least if you've had a conversation outside of the situation and sat down and talk to it about some, what about it with someone else? Then you've at least got another person's view as well. So you've given you've given some space. You've had to think about it. You're going through an into me do a tree. Okay? Yeah, and you don't want to. You don't want to go to direct confrontation, but what about your conversation with the F two or the S C six? This conversation with the F two? Is that okay? The sort of yeah, it's fine. I think it's it's probably not okay, But I think that's probably an initial reaction, because I think putting myself in that situation, I would probably say, Oh, it's OK, They're just joking So I probably would think that initially, but it's only when you start, then step away from the situation and then you think, Oh, hang on a second. Actually, that's not a really a very acceptable thing to say. And just because people are accepted that there's a level of kind of like we like to say banter or joking around in tour meetings and things that people will say, actually, is that acceptable and going forward? Should we x um, like the lady was saying in the talk the other day, You know, just because that's how we've kind of grown up expect being taught is actually what we should be expecting for the future. And actually, you know, for that f t She might have been thinking sitting in that meeting, thinking I'd like to be an orthopedic surgeon. And then she hears that comment and goes, Oh, actually, I don't want to work in an environment like that, so I think after you've said that initially, maybe thinking about it and going back in and having another conversation with the FDA and say, Actually, no, it's not an exceptional way too to talk to someone. And I actually have put this up now as an issue. Yeah, that's actually right. So, um, you know, you're talking about the survivor bias, which is which is something which is is really a really interesting concept of Yeah, you know, it's normal. It's normal. It's not anything to worry about. I survived that. You have to, you know, this is this is you know, if you're just not strong enough, then that's your problem. It's mine. You know, it's that sort of, um, and again that that that leads back to that. Um, you know, you're creating a sort of, um, environment. And what you're suggesting is that somebody isn't feeling so that if you may be feeling that they've been, uh, that they've been it was a misogynistic statement or feeling the impact of that. You've just you've just denied all that so that they think oh, maybe I'm overreacting, you know, and and that that in itself is it is negative behaviors. Okay, does anybody else have anything to add for Group one? Somebody mentioned that you probably wouldn't hear that comment made about the other way around. A male, uh, I didn't have ever heard. Uh, that's all right, Blake. Has anyone had it the other way around with something that might be perceived as a soft skill, though something like communication. Where has anyone ever had it? That way around that perhaps a soft skill is perceived as being more feminine. And therefore, when a man does it, well, then it gets said, as you did that, all right, For a guy just putting out there, I think sometimes you get Oh, you did that. All right. For an orthopedic surgeon, yeah, often said. And protective characteristic. That's yeah, But there's other things where you could see people say that about different specialties, whereas the gender is particularly divisive because often it's one way, but not the other. Yes, 100%. And I've definitely heard it, and I'm not entirely sure I haven't said it, actually that Oh, that's pretty sensitive for a guy, or you know something along those lines or, you know, it's definitely, you know, it's a thing you say stuff without really realizing the impact of what you're saying? Okay, um, let's go to your small group too. So can I have the representatives for small group to please? So, Yeah, that'd be me. Um, so in this case, sorry. Should I just said Sorry. I'll just summarize it. My apologies. Uh, ST 5 ft and ankle surgery. Um, during clinic, you see one of the consultants longstanding patient's. They seem disappointed to see you in, uh, instead. But you make an effort to make them feel at ease. You take time to review the history, you thoroughly examine the patient and you come up with a management plan. Patient's happy, then the consultation and thank you. Then comment on how well you speak English. You were born in the UK Do your parents are of Sri Lankan origin? You tell your consultant you said that they were old school and didn't mean anything by it. Different. So, um, I think this is not an unfamiliar situation for a lot of us, including myself, who obviously sounds like I was raised here. Um, So I think the main thing is it is a microaggression. The what? The patient is question is some implying that perhaps your English they wouldn't expect your English to be particularly good despite, um, you know you having a full conversation and explaining everything very clearly to them. And, you know, by the end, they were happy. They're not. There's no they're not, you know, unhappy. They're not overtly racist or, um, negative towards you because of it. But there's an implication. One without any basis that your English would not necessarily be that good. Um, now there's there's two issues here. There's because there's that one from the patient. But then there's also an issue from the consultant because you sort of mention it to them and they sort of wave it off. They go, Well, it's, you know, it's the patient's old school. It's a it's it's expected. Don't worry about it. And that in itself is also another problem. Well, a microaggression a problem in that they you've raised a concern. You know, you're concerned about enough that you have mentioned it to the consultant, and they have basically waved it off as, uh, nothing to worry about. Um, so in terms of addressing it, I think I think it's difficult to address it to the patient themselves. I mean, you've had a good consult scheme of things, you know? You've delivered good patient care. They're happy and everything. Everything's fine. So in some ways, I think I think from the group, everyone's saying wouldn't so much raise it with the patient. But with the consultant, uh, it was a bit of a concern, because you'd say, Well, um, you know, I've I've raised a pretty valid concern, obviously. I know raised, um, speak English, You know, fully well and yet, uh, and I've made that as a concern in the patient. Consultant just waved it off. Not even a bother. Don't even worry about it. Um, so I'd maybe mention it. Well, actually, maybe is a bit of a concern. You know, um, it may be with this patient was fine, but in other places, patient's, Maybe they maybe questioning whether your educational, maybe your decision plans are not necessarily up to snuff of your English is not necessarily up to up scratch. So I think that's that's where we sort of got to raising. I think it should be raised with a consultant in private. Obviously, um, and just and just see what happens. What? What their responses would be to that. So, yeah. So it's a couple of concepts in the micro invalidation. So, you know, So they're dismissing your your feelings about it, but also the, you know, Was that a micro insult? Was that a assault? Oh, sorry. Can you hear me? Can anyone hear me? Yes, you can. Uh, you don't say. At least he's Yeah. Yeah, So that, you know, it's an example. Micro validation. Is it by the consultant? But also is that a micro insult? I would argue that micro assault that, you know, that's that's quite a negative statement. Oh, well done for the English, is it? That's very that's very patronizing. That's very, um, that's, you know, that is very much, you know, that is a where you're from statement that it bore no relevance to this conference consultation. It didn't have any, you know, there was No, um there's no way you could sit there going or Well, it was just somebody being kind. Well, uh, I think that you didn't sit there going Well, your English is good to, um you know, it's not. It does. You know it doesn't. It's not, uh, and And it's interesting, isn't it? Because we wouldn't say that the patient. But why not? Why not? Um, why not sort of say to the the the patient Say, that's interesting that you complimented me on that Because, actually, um, you know, I was born in England. Um, but what made you want to say that to me? Because and that's you don't you can say it in a really friendly, really positive way, but actually, just make them think about the statement that they've made because they might be continually making these sorts of what they consider, um, friendly or, um, statements. But actually, that's That's quite a you know, that's quite a negative statement, isn't it? What does anybody else think about that? Sorry. It's in the chat, isn't there? I I have this a lot. These, um and I, um I've had this for years and years. This sort of comment and I've married the white man and his, um, and his family often to take things like this to me, and I am, but it's but it's a generational thing. And it's, um I've never had anybody young say anything like this. It's always it's always the elderly. Um, I don't know what other people would say, and and you almost I always feel that you have to give them a You know, they're they're the Brexit devoting generation. You know, they're they're they're the you have to sort of give let them off a bit. You know what we expect of them, Really? I'm equally patronizing in my response. I don't expect better from from people of that generation. Um, I write the month, you know, they'll be dead soon. I am. And that's how that's That's how I deal with it is just by diminishing them, you know, um um, because they've diminished me, Um, which is not healthy, really, for a therapeutic relationship, which should be of mutual respect, you know, Um, but I So I like your point, actually, Helen, about saying something, saying something in a kind way, you know, which which actually challenges them. Yeah, It takes a great position of strength from us as a doctor. Yeah, and that's, you know, And that comes with its own elements, doesn't it? You know, uh, you're worried about breaking relationships, but at the same time, actually. And I take on board what you're saying about people who are who are older, but actually Well, yeah, Lauren Keys, Um said, um, you know, what about instruments? Intergenerational education? Inclusivity? Actually, you know, we are 2023 so whilst there is an older generation and and you know, they're holding them to a standard, um, of of, you know, of modern times, But actually, is it okay that, you know, they're They're they're using mobile phones. They're they're, um they're using their iPad to to use facetime. You're not keeping them in the the sort of dark ages from communication or from So so why not hold them to to at least some, some standards, that of of what is of what is reasonable and and kind of inclusive behavior. And it doesn't mean, you know, yelling at your you know, if that's the appropriate. But but actually, it might be just calling somebody on it, because they might just not be aware. And as I said, as somebody who I I'm not much perpetrator actually being called on something is really important, because sometimes things are just so ingrained that you're unaware that you are causing damage. I would just, um, say Helen, like, do you not think that some of this is our own unconscious biases about that order generation that they perhaps won't understand where we're coming from or that we we are assuming that they're not willing to learn? Yeah. Yeah, definitely. Ageism is definitely a one of the one of the characteristics. Definitely. Excellent. Um, brilliant. Anybody else wants to add anything to a small group, too? Out sunny. Mhm. No, No. Okay. Um, so it's small group free. You're an X to an orthopedic lunch teaching hospital. You're in the same sex relationship with your open about what's in the registrar room. You're chatting to the other registrars, and they're discussing in the new junior doctors being upset. What issues does this race? Um, So, um, yeah, we we discussed this. Um, um we felt that in terms of the issue, that's, um, quite old fashioned kind of term now, and it's quite derogatory. So that's one of the issues to, um, in the changing of itself. And, um, it subsequently creates an uncomfortable working environment. Um, and it's kind of more difficult because they've acknowledged it accepted it and it just it by saying no offense as well, so that that's the other kind of problem. Aside to that, and, um, ultimately creates a divide between registrars and the juniors, and it's not a conducive learning environment. Um, in terms of how to address it, um, we we thought, as a group that it's kind of worth having a conflict and challenging it in that environment and saying that it's uncomfortable and derogatory. Um, but in terms of the junior doctor who's crying, the first step would be, um, uh, information gathering and reassuring as best as possible. At that point in time, Um, if it continues to be, um, you know, an issue and it's continuously said with without it being properly addressed, then then we felt it was appropriate to escalate, but otherwise not in that immediate setting. Okay, so sort of addressing it. But but stepping away from from there, So it's sort of taking that person to a safer place to talk about it? Um, yeah, the it's It's the fact that hasn't acknowledged that it was poor behavior, you know, they turn no offense, mate. You know, don't take it personally again. that that leads towards the sort of the the sort of micro invalidation doesn't you shouldn't get upset. Don't overreact because, you know, I'm just joking. But also, it's it's sort of, um, that acknowledgement of poor behavior, so they're aware of what they're doing isn't correct. But actually, still still behaving in that in that negative or making statements which are which are negative, which is, um, again, is that creating an environment which is which is inclusive, but also, you know how, um uh, whilst, uh, you may not be offended, you know, people listening to that Maybe again, it goes back to that first scenario, doesn't it? Is what impact are accepting. Um, these these sort of micro aggressions have on the people are witnessing that and and and feeling that that is normal behavior. Great. Does anybody else have anything else to say about? That's more good. Okay, how to how to respond to my progression. And first of all, it's like we've already sort of alluded to, which is it's entirely personal. So you get to choose this. It has been perpetrated against you, to you, and therefore it is your decision. And if you're somebody who has experienced microaggressions so frequently. You may not have the emotional bandwidth to to deal with that micro aggression. But actually, if you do or if you're a person who is, you know of a lot more power and privilege, a lot less less sort of hammering that you're getting on a daily basis. Actually, maybe you have more ability to to stand up. No, no, no, this isn't right. Let's let's discuss this because it's not comfortable doing that. So, first of all, they suggest you discern. So you work out how it made you feel. So do you. What was the impact? Just let yourself feel those emotions. They suggested that if you feel really angry with what's been said, then you're probably better take a bit of a step back, having a bit of a breathe about it and then and then working out your response rather than reactively um, responding to it. Whereas if you feel more confusion with what's been said is and why would you say that to me then? Actually, that's that's that's very valid to sort of do that from the beginnings and then defined. So challenge then, So you know simple things. Like what did you mean by that? The natural response to, um, to being sort of, um uh, questioned on my progression is actually, I didn't, you know, like that. And that's, um and that's the whole intent versus impact elements. So whatever you intended to say as the perpetrator or they intended to say as a perpetrator for what your intent was, however, this is what the impact had on me and then just leave it with that. So let let them understand or hear that that it had an impact on you because you may not get a result you may not get as your response that you want to hear, and then you decide you just like how you're going to, how that's going to impact on your future relationship with that person. So this may be a friend, mate, who said this to you? And it's something you you want to build or strengthen your relationship. This may be somebody who actually very negative in your life, and actually you prefer to to not have them, uh, not have exposure to them, and it may be that you don't actually have a choice about that. But it's working out how how it's going to impact on your future relationships with and then the other side of things. So the person being called out in a microaggression So if somebody is actually saying to you actually do you know what Um, what you just did or what you just said has has affected me. So first of all, you have to be aware that whatever you'd intend it, that doesn't that isn't more important than how the person experienced it. And that's really hard and said No, but I didn't mean that. Well, it doesn't matter because you still have the same same impact. So of course it matters as in you know, you hadn't you hadn't meant to, but it's taking a step back and go OK, well, I hadn't meant to do that. However, that's been the results. So how how can I not do that again? So I suggest you should seek to understand the experiences so you can't have lived experiences in in the variety of marginalized groups that we're talking about. But what you can do is you can talk to people who have got lived experiences. You can read about it or you can about a trillion YouTube videos. There's there's a really good BBC paranormal drama about it. There's there's actually a lot out there to to, um, give you that that information. So, um so, um, you don't have to make that person responsible for for enlightening you on the topic. You can find out yourself, so believe your colleagues. So if they choose to share, actually, Do you know what? This is not unusual for me. I get this all the time. A little bit like this story is just saying, actually, you know, she she stole repeatedly those sort of statements. Those those You know, microaggressions so much, though, that they become normalized. It's it's going okay, Don't play Devil's Advocate. Don't get defensive here it and acknowledge it. And you know, you other than saying, actually, I'm really sorry for that and not trying not to do that to other people. And then and this is a really difficult statement. Um, as I say for somebody who's a more privileged position that get comfortable rethinking what you thought was true about the world because you experienced that is, um is likely not the reality that a lot of people are experiencing. So you have to accept You've probably been complicit in producing that inequity. Uh, so that's the end of microaggressions. Um, and we're going to swiftly go onto assertiveness. Um, uh, your your side of things whilst not stomping all over other people. So what is assertiveness? Assertiveness is the ability to speak up for ourselves in a way that's honest, positive, calm and respectful of the rights of others. So assertive isn't some pickle over people. I'm not going to tell you what came up on my Google search when I looked up stepping on other people. I say, uh, for images. Um, but anyway, we'll come up with this one. Um, so, um, being assertive is not some people over of people not taking into account of other other people's rights or feelings is not seeking to dominate others, blaming, attacking, finger pointing, cutting people off using frustrated, angle angry times, because that's aggressive communication. And a lot of people mistake assertiveness and aggression for the same thing, and they are very different. So can I have, um, a little bit of, uh, group talk? So, um uh, can people come up with? What's the difference between assertive and aggressive? Please, can you ask the question again? Oh, sorry. Yes. So what's the difference between being assertive and being aggressive? Point forward? Okay. Thank you, Mr King. Let me video. Okay. So it's being direct and respectful versus dominating the conversation. So me being assertive isn't effective. Thank you for talking over somebody or refusing to hear their side of things. So it is having a conversation where you are directly, um, putting your point of of your cross, but also respecting their point of view. It's stating a preference about silencing or controlling others. And it's asking rather than telling it's allowing room for discussion. And it's very different than the way that many of us do communicate, which is the other side of things. Passive communications. So you're so worried about being aggressive that you're passive. So you, um, uh, you don't have opinion or you allow other people's opinions to to take the forefront. So that might mean seem that you're nonconfrontational. You're you're a good team player. Well, that might fail, actually, to communicate your needs to others so people don't know what you want or what your needs are, then you're not going to fulfill them. Um, so if you quietly accept the decision of others and it can be a lack of confidence, actually, that passive can become passive aggressive. So you've you've you're upset that your needs are not being met, but you're not. You're not allowing people to see what those needs are. So you're clearly unhappy, but you're unwilling to indicate there's a problem or you're saying, um, no, I'm fine. But then talking about the problem with behind other people's back or not directly discussing the issue. And, um, so I'm not talking through or somebody else. So if we have an example, you're in a trauma meeting. You present a case, a distal tibia fracture in a patient, which you plan to operate on today. You've seen the patient prepared for the case. The consultant asked you about the skin integrity and swelling. You haven't checked it. The consultants really cross. They do. It's your poor work. They point out that if they've been bristling, grow swelling, your plan wouldn't be suitable. You realize that they're probably right. You should have looked, but you feel really embarrassed in the way that that's been presented. So how should you respond to that? Hi. I can turn the phone off. Right. How is she to respond to it? So somebody called you up in the trial meeting? You don't think? Oh, can you guys hear me? Yeah. Very crazy. Yeah. Um, so somebody calls you have control meeting, but actually, they're really mean about it. So how what do you do so for me, So yeah. Um, So number one, I guess, is to reflect on your own practice. So perhaps you should have checked the swelling. Is that something to take from that? It's so like there is something to take from it. Um, and then recognize that you're unhappy with that interaction and see if you can work out what it is that's made you so unhappy. What you're getting from the other person that's making you feel unhappy and see if there's something that you can raise all discuss with them to explain why you didn't. There might be an explanation because I don't know. They came in at 7. 30 and you didn't have time. Yeah. I mean, you've gone to see the patient, so it's something it's your ms. So I think I think it's reasonable to say it, you know? You know, I did make a mistake, but is that the right venue to tell people they've made a mistake to sort of yell at them in a drum meeting? Is that okay? It's normal in some places, but should it be is it okay? I think the trauma meeting is a good place to share learning from this kind of thing. So you don't want one on call registrar making that mistake and then the next on call person doing the same thing. But I guess that there are ways to share. Um, this sort of learning. Yeah. Perhaps it's been raised the morning the day after, so because they we didn't operate on that patient because this one, it was too much. And we lost an hour of trauma list of time because we had to rejig the list and the first case couldn't go. It might have been a calmer environment to raise it rather than in the heat of a trauma meeting after a night shift. Yeah, So it's funny saying I think it would be worse if if they didn't say something. You should probably They're probably talking about your back behind your back. I think there are ways of saying things, though, aren't there? There are. There are different ways of of sort of acknowledgement of, um uh, you know, it's one thing about teaching, so I think we'll we'll would agree. Yeah, that, uh, you know, the skin should have been checked. That's a reasonable thing to go, actually. Do you know what? You should check the skin because of this reason, but is it okay to be yelled that to be yelled at or somebody to be getting cross at you? No, that's That's not reasonable behavior, is it? Um, and I think we normalize a lot of behavior. Um, as being okay, but so you can you can You can give feedback. You can give feedback in a in a public venue. You know, you were saying, Well, what about in private? But actually, it is a learning point you probably want other people to hear, but you don't have to do that in a way that humiliates the person who's is that there's there's different ways of achieving feedback without actually making the person feel terrible. I don't know. One to the other. Consultants in the great thing completely agree, Helen. And, uh, I think, Mike, uh, from my and for all the trainees, that is the trauma meeting is that opportunity. I don't think it should be left to another time, but as you've said Helen, it should be raised in such a manner that it doesn't cause offense. And, uh, but you know it. It's a teaching opportunity. And that's what trauma meetings are. Unfortunately, because of other stresses, uh, and other demands on, uh, the people in charge of the trauma meeting, um, they may perhaps not handle the situation and the disappointment as well as they could. And so I think there's a whole school of thought about going into trauma meetings generally, because we know from a knishes excellent surveys that that they're a source of much bullying, undermining and harassment, um, e d theaters and Troy meetings. And so we need to change the culture. So I think the example is a is a great one. Thanks, Helen. So, um, if I go back to to go back to my could, I could I, um um Oh, yeah. Please sorry. Got it. OK, well, because I'm going to be very guilty of Survivor about bias and, uh, defensive behavior ignoring impact rather than intent. A patient has suffered because of that, Uh, that patient's going to be canceled, possibly for seven or eight days. Um, as a result of this overlooking that, that that's serious. Um and, um, doesn't that merit a serious impactful response from the consultants? So it's It's impactful, isn't it? It's the it's I mean, in that particular scenario, you could argue. Actually, if it's not, the registrars fall to the patient's got a swollen ankle so that that would have happened irrespective, it's just the surgical plan wasn't wasn't a necessarily a good one. They might have lived next fix that day instead. But, uh, sort of more importantly, is you can you can get the point across of of actually, this this is, um this is, you know, the learning point. And if you feel that it's a situation where actually, um uh, not enough do care was taken. And, um uh, the, uh, the situation warranted them. Uh, sort of more of a discussion, Actually. That's when going into private to have that discussion with the training again when you've had a chance to pause as well. Because you know your your own emotional responses are not necessarily helpful or in in the situation, because, you know, you've got a lot going on trauma list Eric craziness, actually, you know, making it a learning point. So discussing it in a sort of in a much more sort of learning point point of view, not a you've done this. But, hey, this is the reason why this is important. And then and then, you know, if you feel it's appropriate, then because people don't necessarily learn from, a lot of people wouldn't learn from a sort of being richly humiliated. What you learn from it is to do the same thing to other people, and then it's a vicious cycle. Um, and and it's true of all of them. You know, I I have have grown up in in that environment, and and I and it is difficult when you're really upset or angry about Sanders. You say, you know, you really care about your patient. You really care that something that's been done wrong. For example, you've got to you've got to take a bit of step away from from, um, you know that they're not They're not Children. They're in their thirties. They are. These are are not, you know, uh, old scolding somebody you know it's not. It's if you don't feel that the that the person has taken on board, the impact of their actions just generally is. And I'm not particularly in this case, But if there's been significant actions and you don't feel that there's been so actually discussing, that is really important, but probably not in a public venue. I don't know whatever people feel about that, Okay, I don't I can't. I'd be really interested to hear what the registrars actually think as well. Yes, I think I would. I would like to be told I would prefer to just be told And, um, and the impact, Uh, you know, I don't I don't really mind if it's aggressive or not. To be honest, I think we all agree that talking about it is really important. I'm just I'm just not convinced about the manner in which that that feedback can be given that would impact was actually I would argue sunny if if somebody you know? Absolutely. Sort of. What's the what's the phrase? The hairdryer? The sort of you know, somebody yelling at you. Um, is that going to be? Is that going to be helpful for your decision making in the future? Uh, any more than somebody going? Actually, the phrases to be actually Beasted is what they Yeah, that's what they use at the moment. I've got a bee sting in the trauma meeting. Yeah, I think Mike, Mike and I were having this conversation this morning. Mike Pollinger. So right, I'm very aware I'm one minute over my time slots, so I'm just gonna I'm gonna, uh, finish my right assertiveness, if that's all right, I was gonna give another example, which was, um, s q six undertaking hip firm who risk is to increase their numbers, but the consultant isn't letting them. When you bring it up, you want to do more. They say your knowledge and skills aren't good enough yet. So, um and I think that's a really relevant example just on the fact that actually is a lot of, um a lot of, uh, training at the moment is trying to is, you know, demonstrating your competencies on the limited operating experiences that you're being able to be exposed to because the NHS pressures etcetera. And so how do you maximize that training, and especially if you if you're able to start from a place of where you feel you're in control because actually getting out of control, you won't feel that you've performed your best, that you managed to get your point across. Um, and if you've got prep time, actually, you know, writing down what you want to say a few times so again that goes back to our microaggression. If you want to, to talk to somebody about my progression there perpetrated to you, it's having a really good think of the way that you can explain. Um, you don't always get an opportunity to sort of assertiveness, but it's just giving you an opportunity that if you have time, that's a really good thing. Now there's the concept of sort of being respectful, um, and that that very much of takes the difference between the that aggressive behavior and assertive. So it's hearing what's being said to you as well as directly, um, taking a point of view and ways that you can sort of, um uh, be fairly direct is actually, it seems like maintaining eye contact being positive. I don't That sounds ridiculous. You don't want to be incongruent in your in your behavior, but actually, um, trying to trying to sort of, um, help to move, move forward so that with assertiveness, you're wanting to actually achieve something you're not trying to trying to sort of, you know, even if what you're trying to achieve with somebody stopping, behaving in a certain way, it's it's trying to help you get that goal together with that other person rather than um so it's sort of a positive outlook about it, um, and giving the person a chance responders we discussed. That's the difference between, um, assertiveness and aggression in that you've also got to take responsibility from mistakes you've made. So you know, it's very rare that in any communication were completely in the right and somebody is completely wrong in their behaviors. And there may be there is an acknowledgement of errors that you've made even though they're small. But you've got to you've got to be fairly self critical as well, in order to to sort of so you're somebody who takes responsibility for their actions. Um, rather than just sort of This is what I want. This is what I want without without sort of same banging. Yes. Uh, you know, I had this plan. This will work because of this reason I've learned from that. And this is this is what I want to do in the future, etcetera. There's the concept of using I language, which is, uh, it's making the situation about This is how I felt by that situation. So not you have made me feel like this. You have done that when you did this that that happened. It's a I felt by being told off in front of my peers in the in the trauma meeting that I was humiliated by that. Um, you know, So that's how I felt. Not you did this because that people instinctively sort of, um, try to put up walls trying to No, I didn't know it wasn't me. I didn't know whether you're going how I felt. You're helping them take Take a sort of step forward with you to in order to gain your resolution. So this is how I felt and they can then help you with regards to, um to making that situation better, or or not happen again. As I said, maintaining our contact and being good listeners so people don't respond well, if they feel like you're not listening to them when they're responding, and I do allow it to be a discussion and then something that actually can be incredibly difficult. Okay, now we're discussing this the other day Is the ability to actually say no to something, especially if it's two people that you respect, Um, that you want to help is saying no, Actually, uh, I don't think that's a good idea or no, I'm I'm not going to be able to to do this task for these reasons, and it's saying it's in a way. That's that's sort of calm. It's not aggressive. It's not. No, I can't possibly do all this work. Oh, my goodness. It's It's crazy. It's saying, Actually, this is a situation for me at the moment, so I'm afraid I'm not going to be able to do that. Right. So those are my tips and tricks on, uh Okay. Oh, can you guys hear me? Yes. I think, uh, we can't hear you. I don't know if you've got a band. Big problem. Um, brilliant. Does anybody have any questions or any statements or a Get off the line, Helen, you've already been on seven minutes over your time. Well, thank you for your attention. And thank you for contributing, because actually, it's really important to have an open dialogue of these things. And as I said before, these, um, these three lectures have actually made me, um, read an awful lot more and a much better understanding of topics I really didn't. So I would strongly recommend that itself. It's definitely They're really interesting topics to look at. Okay. Thank you very much. Hi, everyone. Can everyone hear me? Yeah. Okay, good. All right. Trust WiFi is working this morning, which is good today. Great. I think it's having a bit of a problem with her. I t So I'm gonna start my talk for you. I'm just going to get that up and put that up there. Oh, where's that gone? Uh, sorry, guys. Okay. Can everybody see that? Yeah. Yes. Yeah. Good. Thank you. Good, cause I can't see you guys now. All right, I'm going to try again this time because last time you worked very well. But we'll have again. Um, So I'm going to talk to you this morning about emotional intelligence. Um, So again, like Ms Chase over the last couple of weeks, it's been very interesting reading about all of these things, which we sort of have a rough idea about. But actually, when you read into it, it's very interesting, Uh, and you can see how it relates to what we do on a daily basis. So, um, so what we're gonna talk about is basically explaining what emotional intelligence is and why it matters to us and then, as always, what we can always do to improve. So So how we can use these things too, to make ourselves better. Um, So I thought I started an example to to to kick off with. It's something we've probably all been in a situation that's similar to this where we're training someone who's who's maybe junior to us. Uh, and we're going through an operation and we get to the end of the operation, and we say, Oh, that was brilliant. That was really, really good. Uh, you know, that was I thought it went really, really well. And then you look across at the other person, and this is what they're feeling like. And this is what they look like. Um, so I guess the question is really how How in that these people have had exactly the same experience. We've both been in that operation. We've We've both been there watching everything happen, seeing how everything works, and then at the end of it, um, you end up in a situation where, um Okay, Mike, is that better? Yeah. You see, that might yes. It's moving now. Thanks. It's moving. Okay. So, in a situation where where We've ended up with a situation where people have had a very different experience. So I guess the question is, how can how can we interpret How do these interpretations of the same experience be so different? So nothing's changed. They both experience the same thing. But how can it be so different? Anyone want to suggest anything at this stage? Don't worry. If you don't want to, you can have different expectations of what you want from the procedure. Yeah. Anything else? Yeah. No. Okay. Yeah. So you're right, Mike. So It's that mismatch, isn't it? Between what people are expecting to happen. But then there's a lot of other factors that might influence that experience, even though it's the same experience is the interpretations that can be very different, and we'll come onto that a bit more later. So emotional intelligence. What is it? So essentially, you know, if you think about what you're what you are like cognitively, you've got intelligence that, you know, like, which is traditionally sort of measured in something, you know, like you essentially into sort of how you know how clever you are in inverted commas, uh, and your ability to problem solve and things like that. But that alone doesn't make up all of your cognitive ability. Um, it's not enough to explain that and that there's this other concept of emotional intelligence, which is the way, essentially, that you interpret situations and your emotions and how the your emotions, uh, can affect situations and and the way you work your way out of those those situations as well. Um, you know, it's it's thought, really that actually, this makes about almost 90% of of of of what, what we actually do so the actual intelligence bit is less important. Some people would say so. Definition, if you want one, is the ability to identify understanding, use your emotions in a positive way to manage, stress, communicate, empathize and overcome issues and manage conflict. So when you put it like that, it seems like something that all of us are used to dealing with, particularly in healthcare, where it's a very stressful environment. We come up against things that difficult on a daily basis, you know, breaking bad news. Um, working in teams, delegating responsibilities, operating in difficult environments. All of these things, Um, you know our situations where where this suddenly becomes really, really relevant. Um, the concept of this was described originally way back in the 19 twenties, um, as a kind of thing called social intelligence, which was It was noted that, you know, some people are just better at getting on with people than others. Um, that's obviously moved on a bit now where it's become more sort of mainstream in in, uh, psychology. And it's essentially, um, something that's become more relevant in terms of business and things like that as well. But it has social implications as well as those for work. Um, so it's popularized in a book where essentially they there's five facets of of emotional intelligence, which will go through to explain the kind of concept and how that can relate to us as healthcare workers. So the first one is is self awareness. Um, so this essentially is being aware of your own emotions, Um, and and the situations that urine Essentially. So someone who's self aware will question decisions. They're not a passive person. They will listen and question decisions not only that others make, but also that they're making themselves, uh, and think, Why have I come to that decision? What's made me thinking that way? Um, they're normally someone that would be willing to ask for help. So again, that's an awareness of your own limitations, but also how your emotions can can affect you within a situation. So if we go back to that situation where you're operating, um, it's quite stressful, and stress is a natural kind of feeling to have in that environment where you're you're trying to perform a task and you know it's pressurized, particularly being trained, uh, and it's a willingness to ask for help in those situations because you recognize that that stress is a is a negative emotion. Uh, but you can change that by asking for help to to to limit the amount of impact that that stress then has on your performance Situational awareness. So this is basically read. Essentially, you wanna put it a different way, is reading the room. So if you think about looking at a situation, you might come up against something where you have nonverbal triggers. So, you know, we we used to concept your body language and looking at people's faces. Uh, and you can tell sometimes can't you that, being aware of that, the the situation not just yourself, but how you within that situation, how your emotions may, um, contribute to how that situation then plays out and then controlling your impulses. So again, emotions are quite strong things and innate characteristic. They can drive you really, you know, towards all sorts of things. Really, Um, but it's controlling those impulses to do things so again, having a check on yourself and your emotions to make sure that what you're about to do is a sensible thing to do. Um, the next kind of areas is self regulation, which kind of goes back up to the self awareness bit as well, because essentially, it's looking at how you control and challenge your emotions. So as these things come up, if we take stress again as a good example, you know some stresses, good helps keep you kind of on the edge of you know, it's it's keeping you on the edge of performing well and and stress is necessary at times. But it's making sure that you have the ability to control that stress and then and then challenge it when it becomes too much. One of the other self regulating things that is, that when you when, particularly if we make mistakes at work. Um, you know, uh, sometimes it's It's easy to feel got, uh, like, you know, it's it's it's all it's not a pleasant experience, is it to to be accused of doing something wrong, But, uh, someone who's emotionally intelligent will resist the urge to blame others. So again, it's it's about self examination and working out exactly what what did happen. How did you contribute to it in that way? Um, motivation. So motivation is another kind of facet of emotional intelligence. Um, people who are motivated tend to be altruistic, so they're they're there to do things for the good of others. Um, it's not all about themselves. Um, you can manage your own, uh, performance by by setting yourself goals and and being motivated so motivated. People are very good at managing their own performance and and and performing multiple tasks at the same time, if you can. If you can be a motivator, then hopefully your own work ethic is contagious to the team, so it has a role being motivated within within the team situation to bring people along with you. We think about empathy. We're all doctors. Hopefully, we're empathetic. Um, but this again comes down to another aspect of that emotional intelligence looking at the needs of others. So that again goes back to. A lot of these themes are recurring where it's looking at situations around you. Uh, and you know, working out how someone else's feeling not just yourself and what not only how they're feeling, but what you can do to understand the needs that they have, uh, to help make them feel more comfortable in a situation and then social skills. So this is not just sort of going out down the pub or anything like that. This is this is about building relationships across teams, uh, and boundaries. So So people who are good at this at work tend to sort of move seamlessly between, you know, clinics, you know, vetters. Yet on with everybody, it's just about building relationships with people and being open and honest. Um, so it's these kind of 55 areas really, That that make up with the concept of emotional intelligence. So I suppose the question is, what? What? How does this relate to work? So why is this important? Um, so I think if we take the first picture there, you know, we're very busy people, aren't we? We often have a number of things going on at once. So if you think about the time that you know, particularly as registrars, we often delegate work two more junior colleagues. Um, you know, we're quite happy for things to be passed on to others because we're busy ourselves. Um, but in that environment where we're just passing things on, if we're not emotionally intelligent and aware of others, we can overload other people. Uh, and that actually has a negative effect on on team working. So, in a situation where you know, you would hope yourself if you were very busy, that you would want your colleagues to recognize that and see that you're stressed and busy, um, and then offered to help out. So so us being emotionally intelligent, you know, can help other people in terms of their workloads and make the team work, uh, you know, much more effective on a day to day basis as healthcare professionals, we obviously have to look after patient's. Now emotional intelligence is important for for our interactions with patient's. Um, if we you know, for example, uh, poor listeners, poor communicators. We're not picking up on cues from patient's. We're not giving them, you know, not respecting their emotions and looking and trying to imagine and empathize with with their situation. It leads us onto a very easy situation where we're going to end up getting a lot of complaints. Um, so things like sitting in clinic and you know, somebody who comes in and talks to you and give you the history when they sit down and then they think they've got that all out. And then you turn around and said, Um, so can you tell me? Tell me what brought you in today shows that you're not listening and automatically you're on the back foot, so you know as much as it is about working with the team, it's also about thinking about how these interactions for our patient's might help. If we're emotion intelligent, you know, we can avoid stress and becoming overstressed. Um, you know, stress is a very, as I said earlier, quite a highly charged kind of emotion. It can. It can lead us into situations which can promote conflict. Um, you know, it can make everybody's life more difficult and and being emotionally intelligent and managing to understand how we can cope with stress and avoid stress. A new stress to our advantage, um, is something that would obviously benefit us. Of course, a number of areas of our work, some of it's quite topical at the moment is burned out. Um, now I think with this this is a kind of combination of all the factors that we've just talked about in that you know, all of these things can add up to burning out. And and if we're not willing to look at ourselves and recognize our own emotions and our own stresses, then we're very, very much at high risk of ending up in a situation where we can burn out. Um, I think if you look at it from the other side as well as that, if if if we're not open and intelligent to the to the emotions and stresses of others, then then we're not being supportive colleagues and recognizing the signs and of people burning out and and and how we can avoid that So really, it's about, you know, looking after each other as much as ourselves as well. Um, So if we go back to our scenario again, um, do you think in this scenario, you know, what do you think one of the contributing factors here could be something to do with emotional intelligence? And if if say what? What? What is it? You know, what kind of characteristics do you think could have been displayed that might have might have been not very emotionally intelligent or emotionally intelligent. That led to that kind of mismatch between the expectations from the experience. Anybody there? So one of the things you've mentioned in the five aspects of self awareness. Mhm. Yeah, that's a good point. Say, what do you mean by that, Mike? So either the person with thumbs up could be not self aware enough to realize that actually, it hasn't gone well or the person with their head and their hands could be self aware, too, or not realize that they're an absolute perfectionist. Yeah, that's a really good point. So So, as much as that What, you know, a negative characteristic of, you know, sort of poor emotional intelligence. Is that perfectionism? So, um, as much as we all want to do a good job, you know, being aware that you know that perfect isn't always achievable number one, and that that sometimes you know what we say The enemy of good is perfect. Um, you know that sometimes what you can do is good enough then then that's that's That can be a negative thing. So that's that's a really good point, Mike, But yeah, you're absolutely right. The the lack of self awareness could be on both sides here. Couldn't it could be that the trainer think they're amazing at training and that and that they've done a really good job. But likewise, the person might have had unrealistic expectations about what they're able to do. Yeah, very good. Any other Anyone else got any comments they want to make for any other reasons? Perhaps? No. Okay, I'll take that silence as I know. Um, so we'll come onto these things. It might kind of already mentioned these. So on the left there is is things that that would be considered to be not very emotionally intelligent. So people who display these kind of characteristics often feeling misunderstood, Um, people who are easily upset can be overwhelmed by emotions, have problems of assertiveness, which Ms Chases discovered overly critical and poor listener. All of these characteristics can add up to being, you know, essentially not very emotionally intelligent. And you can see how these can have negative effects, particularly in scenario. We've just described in terms of an operation, someone who is emotionally intelligent, you know, understands how their emotions can be linked to their behavior. They often come and composed. They can influence others towards a common goal, handle difficult people with quite strong willed. So I think if we go back to example, might might really nicely, uh, mention that that that it might be a lack of self awareness. I think you could accuse both people in that scenario, perhaps being not very emotionally intelligent because it might be that the trainer was was not being particularly assertive in trying to to to guide that person through the case. Um, they may have been stressed themselves and slightly overwhelmed by that stress, UH, which has again impacted on their performance. They might be a poor listener. They may not have been listening to what the trainee was saying. Um, they might not been able to pick up on the cues that they were finding the the actual experience quite stressful. But you can see how easy it is just by changing a few of those things just to how you can improve the situation quite dramatically. You know, remaining calm and composed, um, allows you to assess the situation that you're in and be be more in a space where you'll be able to pick up on these cues, understanding how stress, for example, or feeling nervous, um might impact on someone's behavior. It might not be that the person can't do a case, for example, they might be technically fine. But understanding that that nervous is sometimes at the start of the case is not is not not an inability to do it. It's just that their their emotions are linking to that behavior and making it more difficult for them. Um, and I think if we can bear all these things in mind, it helps us to to influence over people towards that common goal. It makes us better educators in that we're able to to pick up on these cues and and help people through these difficult situations. So the good news is that you can improve this. Um, hopefully, um, the first thing really to think about is is being a sort of mindfulness. That concept of mindfulness now by that don't mean you have to meditate or anything like that. But it's essentially, um, having a critical look at how your emotions play out. So a lot of the time it's it's thinking about situations that you've been in, uh, and then thinking about what the situation was, how you were feeling at the time. Um what things might have influenced those emotions, uh, and how you can essentially come up with a strategy to avoid being put into a similar situation next time. So it's there's some quite good exercises on the Internet if you search this stuff that that allows you basically to to critically appraise your thought process is when you have these situations in which you found things particularly stressful. Uh, and hopefully, by doing that, you're making yourself more self aware by recognizing, uh, how your emotions have played out in that particular scenario. Uh, and also the effect that that has on you because, as I said, it's not always a negative thing. It might be that in a scenario you actually realize that your emotions helped. So it's not necessarily always a negative experience. It's It's something about looking at how how you can use that next time to avoid a similar situation. The other thing is looking at your perspective. So are you a glass half full or glass half empty person? So some scenarios you can frame in a very different way, so you could look at that experience that we've just described in the scenario as being either a positive or negative experience. So both people in that scenario could take take things away. Now that might come across as a negative experience for for the person on on the right in the picture. But, you know, it doesn't necessarily have to be that way. Maybe, you know, it was the fact that they were slightly stressed out that that did it. You know, if you look at the positive things that happened, they got to the end of the case. Um, you know, they technically didn't do anything wrong. So it's not a lack of ability, which is often where we all jumped to. It's it's working out. You know, That actually wasn't all bad in that situation. That there are some positives that have come out of it. So it's shifting that frame of reference away from a negative, uh, perspective to a more positive perspective. Uh, and if you can do that, then you can work out that actually, you know, a lot of the time, despite what we think, um, you know, things are not as bad as they see. Um, and then hopefully, um, it's looking at, you know, the other thing that that can set things set us off is triggers. So a lot of the time, you know, because of our innate characteristics, were all triggered by things are things that irritate us. There's things that can set us off and make us more stressed and angry. And it's essentially looking at are the things that trigger us and working out how we can recognize those triggers coming and and how they how we can avoid those, uh, negative behaviors that might be associated with that. So, you know, for example, if there's if there's something, you know, that winds you up, uh, you know, it's it's working out how what things you can do, perhaps to mitigate, uh, that. But also what things you did last time. You're in that situation. Uh um, you know, uh, calm yourself down, for example. So there might be something that you do that that helps you when you're feeling particularly stressed. You know, you might like to go for a walk, that kind of thing. Um you know, for example, for me, I got quite stressed out at work. Uh, something beyond my control. But it did. It did make me cross which is very unusual. Um, and I knew that the thing I had to do to calm me down was go for a walk around the around the hospital just because staying in that scenario would have only made the situation worse. Um, you know, and I still had still had work to do, so that recognition of a trigger coming, uh, and then thinking how you know it can be something as simple as just going to sit in another room. But you know, just what you can do to to reduce the stress that that trigger has, um is important. And knowing that that way of calming yourself down or change in that situation, um, is something you can have in your toolkit for when, when you get stressed out. So it seems very simple, these three things, um, and there, you know. But there are things that require a bit of work, and and, you know, that's the thing with this, it's it's not something that just happens. You have to work at it a little bit, um, to recognize these things. But certainly doing it is something that that can benefit you greatly. Um, So I just had a couple of things just to think about. So do we think that this is something that's innate, or do you think it can be talked? Is it something going to learn? What do people think about that? Um, I think it's probably a combination of both things. I think there's probably, uh, certain qualities that innate um and then obviously it's easier for certain people to probably reach that level of emotional intelligence than others. But I think it's definitely something that you can also learn, um and kind of reflect on and improve on as well. So probably a combination, Yeah, I think that's true, does it? I think that's probably right. Does anyone have any alternative use to that, or is everybody sort of agreeing that they think it's a combination of the two things I can't see the chance. I think I agree with pretty. I think it's an element of both, but then I think there's also an element of lived experiences, So if you do try to express your emotions and that's received in a negative way, maybe that makes you less inclined to to then try again in the future. Um So do you think nature and nurture do play a part Positively animated? I think. I think that's a really good point, Kate. That that you know you is that, you know, willingness to try and and show show that awareness that sometimes if it has a negative connotation, then maybe you're you're more likely to to avoid it. Um, so that's almost like suppressing an innate characteristic, I guess. In a way, um, but yeah, I think you're right. I think when you look at it into the reading of this, there's there's a lot of debate about whether this is an innate characteristic or if it if it is purely a learned experience. But But I think you're right. I think you're right. It's It's a combination of the two things you some people just naturally are more emotionally intelligent. But as I said, the the good news is that there is general acceptance that that we can all improve no matter where we are on that spectrum of being emotionally intelligent, that bearing in mind, these, these things can can definitely improve. Um, another area. I just thought I'd ask what people thought about was It's been it's come up now that you know, there's been some studies looking at this as a as a potential discriminator for applications into medicine. Um, and and certainly some some trusts use these kind of personality tests in a way, um, as a means of of ranking people for consultant interviews. So what do people think? Think about that. You know, from the medical school perspective. Say, you know, do you think it's a It's a good tool. It should be used as a discriminator for admitting people into medicine. Or I think it's really worrying because, um, for two reasons First of all, um, any one of us can become clever enough to answer an emcee key. Were clever people with the top 7%. Aren't we people in this, uh, you know, we can we can answer MCQ is in a way that make disappear more emotionally intelligent than we are. And then you just hired a bunch of cynical, crafty, devious people, you know? Um, but secondly, I think that emotional intelligence, the you can learn anything. You can change any behavior but the but you change it better if there are positive rewards. So if you see if you see that by, um, making empathic comments makes the consultation go quicker. You're more likely to then adopt them, even if they don't come naturally to you. I think emotional intelligence, the positive effects of it are so slow. And so, um, gradual that, um I think for people for whom it's not innate, um, I find I find it very hard to become more emotionally intelligent because, um, there is no immediate feedback for when I try to into it make a behavioral. No, that's a very good point. Call it. But I think, um you know, if you look at this thing, it's is difficult. I think if you're not innately you know, that have the innate ability to do this. I think one of the things is that they you know, when they've researched this, what they have shown is that as you as you get older and you have more experience, you certainly do, um, seem to exhibit more qualities of of, you know, of high emotion intelligence. Uh, and I guess that's what you're saying there is, that is that it's not something you can change overnight, which kind of goes back to what I was saying in terms of how he can improve its it's a sustained, um, effort to improve it. That that makes a difference. And I suppose that's why it takes such a long time. You know, that's why older people with more experience tend to tend to. It's a bit higher emotional intelligence because they have that lived experience that Kate was talking about earlier. Um, I mean, I think personally, you know, in terms of I don't think it's necessarily a good discriminator for medical school. Uh, you know, I'd be worried again about it like you say, Cold, deep, being cynical, um, that it might be something that people can can blag as it were. It depends on the test you use, I guess, as well. But I think it's a bit worrying when you you have to take these things around that you can't. As I said to you earlier, it's not motion challenges is now thought to be so important within healthcare that that it's, um, you know, take makes up a large part of what people appreciate being cognition. But there's also other aspects that that add to our cognitive ability. Um does anyone else have anything they want to say about that? Or I think the only thing that I wanted to add is that I find quite interesting is, um when I'm reading the pros, Well, well, I guess the things that made you more emotionally intelligent and then the things that make you less emotionally intelligent. I think what I found interesting is that I probably had qualities in both. And actually, I didn't realize that maybe some of the qualities that I thought were maybe a I guess a positive thing in terms of, you know, sometimes you won't say no to people because you feel like you're being helpful or you don't want to disappoint people or things like that that initially I'd probably look at Okay, that's because you're empathetic or you care about what other people think actually could be inactive in a way towards emotional intelligence. So it could be something that, maybe like, we were talking about that balance of kind of assertiveness, Um, and kind of knowing when to be able to say no, but justifying in a kind of manner that is amicable, etcetera. Um, how That is also important. And that actually contributes towards your emotional intelligence. And it's not just always just being nice and friendly and helpful all the time, if that makes sense, No, absolutely. And and interestingly, people who are, you know, on the higher end of the emotional intelligence scale don't tend to be sort of terribly creatives or innovative, innovative, which I know It sounds a bit, you know, it's a bit. Sounds a bit counterintuitive, doesn't really, but but because because they're worrying so much about everything else that you know, they don't have that drive, that people are less intelligent, automation, intelligent, have they tend to be the ones that you know. They're very focused on certain things, you know other things. But as you said, you like, you worry about pleasing people, things like that. That's very much a high emotional intelligence kind of characteristic. But but as a result of that, you don't tend to be the people that are driving sort, creativity and things like that. That's a good point, though. I think I don't think anybody's you know, one or the other. There's there's characteristics we share across everything and and it's I guess it's just being aware of these things and and and how these these things can influence your behavior. Um, so thank you very much for that. Um so things I just want you to take home is that it does matter to how we interact with others professionally and socially. So again, as we're talking about earlier these things, you know, often work helps with things socially, Um, and think, you know, those professional environments which we working, which are very stressful. There's interactions we have with colleagues, patient. You know, all of these things are stressful environments, and it's just thinking about how how that intelligence matters and during those interactions, um, self awareness key. So with all of these things, it's it's examining self examination. And looking at yourself is really key to understanding these things and how you can improve. Um, I think we could all be better at noticing adapting to needs of others, but also being aware of ourselves. And it's quite a good quote from one of the things that just said, you know, start making here's of people who help other people. It's not just the person top of the mountain, you've got their first. It's all the people that helped him. So if you want to encourage behavior, it's good to recognize it and call it out What it is. All right. Thanks very much, guys. Thanks, Mike. No problem. So just to make everyone aware that actually, this is an interview question. So last year in my consultant interview, I was asked what emotional intelligence was. Did I have it? And an example of how I could demonstrate that I had it. So, uh, these topics are becoming more prevalent to talk about which is good, but could definitely catch you off guard in your interview if you haven't bought about things like this. Thanks, Mike. Um, Okay, so Okay, so hopefully you can see the QR code on the left. If you just scan it, you should take you through to slide. Oh, and we'll create a world cloud of what you think resilience means or what it means to you. So you can put as many words in as you would like able to cope with stress, not giving up, withstanding pressure. There's 33 of you, so hopefully we get more. Keep going, guys. Ability to bounce. Yeah. Toughness. Tough. Okay, keep going. Adaptability, strength, thick skinned toughness is becoming a recurring theme. Emotionally strong. A consultant TNO surgeon? Yeah. Rebound from negatives. Not giving up. Working hard coping mechanisms being flexible, thick skinned, becoming a recurring theme. Okay, rubber band not being phased. Withstanding pressure. Okay, Not giving up, becoming a recurring theme as well. Good. So, uh, lots of different opinions there about what resilience is or what at the moment it means for you. So we will just start different screen share, and we'll go through resilience. Great. So hopefully you can see the slides. Now, as we're going to talk through resilience and we've covered what resilience means already to you. Uh, and we'll come through in a little bit and talk about what resilience is and whether we have it or not. So I thought, Where do you start with resilience in surgeons? And actually, when you go to Pub Med, there's very little already on resilience in surgeons. There was one paper that was on spinal surgeons in Germany and a paper and general surgeons, um, but very minimally touching on resilience, mainly with the use of, um, doping medications and none of them from the UK resilience in orthopedic patient's is published and predominantly looking at patient's waiting half plasty or athletes and return to surgery. So resilience is your capacity to cope with change and the challenges that you face. And as somebody has mentioned in the word cloud, it's an ability to bounce back in difficult times, and you may consider it your ability to recover from adversity or experiences of adversity. But what it isn't is just keeping quiet, sucking up bad situations or bottling it up, feeling the need to just be strong, keep your head down and get on with it. And it definitely isn't a personal failing on in individuals part. And it's not having immunity against adversity, But it is a dynamic situation. So there are times where you will be more resilient than you are at others, and I'm sure we'll we'll come across some of these during this talk. You have to keep it in context of what is going on around you both I/O of work and the confounding factors that affect how resilient you are on a day to day basis. And often this comes down to the situation and how relevant it is to you and your the personal involvement you have in that situation and the effect it has, perhaps on your career progression. We have lots of confounding factors that affect our resilience and some of them we've already touched on today already things going on in and outside of work and the volume of work that we have and how it impacts on our behaviors. But where is the adversity actually coming from? That we're having to bounce back and a lot of it comes from the system that we're working in. We know we're understaffed, we're overworked. We're in a position of extreme responsibility and often feel both emotionally and physically undervalued within the service as well as financially. And we're living in a system that is also failing at the moment. With the cost of living crisis, adversity often comes from our career trajectories and the internal pressures we put on ourselves to perform and to continue to progress in our training and to take on additional roles as well as the external pressures that we feel jumping through hoops to complete training, for example, and we often forget the bystander cost to our careers of Those are friends and families that are around us that have to pick up the slack because we're late home again or because we've stayed on to see an interesting case or because we're going in at a weekend because there's a W W L I list and we need to get our numbers up. And then there's the personal cost, both financially and emotionally, again related to a Correa's. And then there's adversity in our personal lives, which again is variable, and there will be times that it is affecting your work. And there's times that it may not be. And it's just being mindful that everyone has these adversities, and you may not know that this is going on in somebody's life. And ultimately, all of these adversities lead to uncertainty in our private and what professional lives. By labeling resilience as a characteristic of an individual person. It's a double edged sword because it's focusing the problem on the person, and it's not thinking about the system that that person is working in and the culture that they're exposed to. We've seen the RCs produce a document editorial piece on resilience. Insurgents do we train the individual Or do we change the system? And similarly, from the BMJ? Doctors need to be supported and not trained in resilience. But actually, even if working conditions were greatly improved, overnight surgery is still a career. That is high stake challenging very high, uh, rate of burn out because of extreme amounts of responsibility. It can feel all encompassing at times. And it's a very long training period. So we do still need to address our own cognitive well being and how we can optimize resilience for ourselves because the system isn't going to change overnight. Um, Mike, or kneel. If you're signed in, you should have admin rights. If you are. You able to start the poll there that I've already lined it up, Try and help you. You Otherwise I can stop screen sharing. But I'll just add on time. It's the very first one. So our surgeons, more resilient characters. Okay, Thank you. Has everyone got the pole? Yeah. Great. Neil, I won't be able to see the results if you wouldn't mind, uh, update to me. Mhm. So can you see the chat, Kate, or do you want me to read out? Okay, So our surgeons more resilient characters than the general public. The answers were yes, 88% know 0%. No idea it's fluctuating. It's just changed to 10%. So, um, as a person, so being a surgeon does not purely identify your values. So what is important to you outside of work? And it's when you're able to engage meaningfully with both your, uh, life values inside and outside of work, that you're able to protect your cognitive well being and that will increase your resilience. So Act has got six main areas and there are exercises online. And if you were to go through act therapy, these would be the six areas that they would work on with you. And the first is just being present. So having an awareness of what is going on around you of your emotions, as well as the team's observing yourself and actually giving yourself compassion, which I think perhaps as orthopedic surgeons were not particularly good at doing and being mindful of emotional intelligence following on from Mike's talk already we need to clarify our values, which was the previous slide, what is actually personally meaningful to you and then to come up with committed actions. So these are achievable goals that you are working towards acceptance, I think, is a much harder one to work on. And this is you creating space for the emotions that these experiences, um create for you and being able to give yourself the time to be able to process those. And finally, there's a process called cognitive diffusion, which, if you like, is a deep bonding of the thoughts that you have, and actually the effect they have. And this is, if you like, is the element of mindfulness and trying to get rid of that sense of impending doom. So I thought we would focus on a couple just because we won't have time to go through or six. And we could start off with cognitive diffusion because it may not be something that people have thought of so much. And an exercise that's encouraged is to try to dispel some of the intrusive thoughts that we have. Um, so I'm sure all of us have intrusive thoughts. You may not want to share them in this forum, so I'm not going to ask you, too. But if you actually genuinely reflect back on how many of those occasions are those intrusive thoughts, actually true? And the first process here is to actually consider that the things that your internal voices telling you are not necessarily true. And they're not necessarily everyone else's opinions of yourself. And I would like you to think of one hurtful self criticism that you have given yourself in the last six months if you haven't got any fantastic, your internal voices, obviously looking after you. But I'm sure everyone has got something, whether it's in work or outside of work, that they have been incredibly self critical of themselves over and haven't looked after themselves going through that process. An example might be that you've had a problem in a theater and you think you're an awful surgeon. You have to sit and engage with that thought. And this is that element of giving your space yourself space to accept it and to process the emotions that that statement is, um, instilling within you. And then you gradually want to reframe this to create space and distance away from that initial intrusive thought. And that's to then think I'm having the thought that I am an awful surgeon, which is just 11 very mild step away from I am an awful surgeon. And then once you're comfortable in that situation to actually move on to, I notice I'm having the thought that I am. And so it's actually trying to, uh, Deep Bond that intrusive thought with reality and try to increase the distance between the two. And so you can reflect on that mental shift that you've made between definite truth. And actually, I don't know that this is true at all. So that's one process for your toolkit, so to speak. The other option that you could look at doing is actually how are you present in a situation, and being present is sometimes quite difficult to do. We're very good at thinking we're listening, but we're not, and I'm going to cover active listening and civility so we won't go into too much detail now. But being present is quite difficult to do, and so hopefully everyone, you haven't got your cameras on. I can't see you anyway, so hopefully you can work through this one as we go through it. So this is a five senses exercise, and in that situation where you need grounding. Either something has aggravated you or you feel stressed, or you're not entirely sure how you're going to proceed with a situation you can focus on five things that you can see. You can focus on four things that you can feel so in theater that might be the suction, the drapes, your gloves, the swab in your hand. You can focus on three things that you can hear, and that might be the anesthetic machine beeping. It might be the sound of a tap. It might be the anesthetist voice or the patient talking. If they're under a spinal, you can focus on two things that you can smell. And that might be if you're in, uh, anthropology list, it might be cement. It might be the diathermy. It might be the anesthetists coffee, and you can focus on one thing you can haste. So one of the things that I wanted to do in the resilience talk and it will lead over into the civility talk. Uh, so some of the concepts from this resilience, um, talk will will predominantly come up in the civility one. And so I've kept this quite short, is that there isn't very much research on this element. And particularly, there's nothing on orthopedic surgeons in the UK and certainly nothing within training. So there is another QR code for you all here. If you can scan it and just spend five minutes answering the questions, which are all anonymous, you will have answered a perceived stress score a brief resilience, score in a grit score. And by doing so, one trainee or a couple of the trainees in the in the region can use that information and perhaps produce a poster of presentation. Um, or perhaps use it as a stepping block to move on to something, um, bigger if they wanted to, um, as a research project. So if you can spend a few minutes doing that, are there any questions from anybody at the moment? Yeah. So 20 responses so far keep going, guys and girls. Okay, so we're sitting around 70% of people feel that they lose time worrying about that rudeness that's taken place. So bear that in mind for the talk. Okay. Uh, so civility, um, is a difficult topic sometimes to talk about so I'll do my best for you guys today. Um, hopefully What we will do is define what civility is, but also the effect civility has on us as individuals and as the team and the system that we work on as a whole. We think about some of the aspects of our practice is where actually we might be at risk of becoming uncivil and to start to put together an idea of having a talk it to deal with some of these situations. But I'm obviously not going to be able to deliver a complete talk it in half an hour, so prevention is better than cure. And so giving some time to think about these um, experiences before they happen can often empower you to handle those situations in a better way than it being sprung on you. So civility is caring for your own identity, your needs and your beliefs. But while you're not degrading, another person's okay, and it's not just as simple as just being polite to one another. You actually actively have to respect yourself as well as your peers. You need to be attentive. It hopefully creates a sense of a peaceful coexistence where we can empathize with our colleagues and patient's. But also promotes collaboration, and in simple terms, it is both socially and ethically appropriate behavior You may have already heard of. Civility, saves, saves lives. And this is a QR code to their podcast, which is available on Spotify and Apple podcasts. Um, so if you wanted to check that out while you're driving to Egg, there's quite a few interesting podcasts to listen to you there. We've covered this already in this group. Around 70% feel that they would lose time worrying about it will come on to that in a second. So what actually happens when someone is rude? Well, there's effects on the recipients, and there's effects on the bystanders. Around 80% are not dissimilar to what we've just seen of. People will lose time worrying about the rudeness that they have experienced. A quarter will take it out on service users, and for that, for us, it's our colleagues, and it's our patient's. Almost half will spend less time at work, and just over a third of people will find that the quality of the work they produce reduces. But what we often underestimate is the effects of people who see that behavior so the bystander effect people who have seen other people be rude to, even if they haven't actually been, uh, experienced it themselves. And half of those people are then less likely to go on to help others in the institution, and one in five will find that their performance reduces as well, even though they were not on the receiving end of the rudeness. So the effects of this actually are quite wide. We have less effective clinicians who are providing poorer care, and it therefore affects everyone in the system. But why is it difficult to just be civil to one another? It seems like a very basic skill to have something that we should be able to do day in, day out, and it comes down to people's perceptions. So what I feel is rude or inappropriate behavior may be different from what Mike thinks is inappropriate behavior. And actually what I think is inappropriate behavior today, I might feel, is appropriate behavior the next day, depending on the context that it's in and the experiences that I'm having that day, and it comes down to also being about my personal bandwidth. So if we imagine today, it's Monday. I'm well rested. I've had nice weekend with family and I know what I'm doing for the rest of the week. There's probably unlikely to be any significant curve balls that come my way and actually today my resilience and my ability to be civil is quite high. I've got a lot of capacity in my bandwidth to be able to deal with whatever is thrown at me today. But actually, for example, I'm on call and by Tuesday there's a pair of prosthetic fracture that's come in. There's an implant I've never seen before and I don't know how to get it out. I've had to order a new kitten that I've not used before. The rep isn't available until certain time. The patient's got lots of medical problems and I'm stressed. I've had an argument with my partner on the way to work and oh yeah, there's that BHS deadline that I need to produce by the end of the day and actually on this day, my personal bandwidth is reduced of what I am able to cope with, that the system throws at me and what other people in the system may send me curveballs so my, uh, my personal bandwidth has reduced. And actually, my own perception of civility has probably changed today because of the mood that I have brought to work. And then towards the end of the week, I get a phone call in theater. The registrars had a problem with a Hemi, and that requires an on table revision that was unplanned. It was a prolonged procedure. The patient is unwell. They have an M I and go on to arrest. We get the patient back, but it's all a bit of a disturbed event. The patient is requiring a lot of support and goes to I t u with an open wound and exposed arthroplasty. I've got a headache. I'm hungry because I hadn't planned to go to theater for a long case. And actually, I then get told there's a rotor gap for the night register phoned in sick and as the encore consultant, I'm going to have to step down if there's no cover found in the next hour. So at this point, my personal bandwidth is pretty slim. My perception of what is civil behavior has changed, and actually what I think is acceptable civil behavior has probably changed in that moment, and it's having insight into where you are on that spectrum throughout the day and throughout the week. So we all have power. We have the power to choose the behaviors that we demonstrate, as well as the power to control our emotions and how we deliver those two other people and that ultimately determines our reputation. And I learned leadership style. And so I'm going to give you a scenario of a scrub nest, calling you as a consultant on call and you're in the middle of a meeting. It's your theater list day, and the registrar is having problems getting the Hemi reduced. They're getting flustered, and the scrub nurse would like you to come to theater. So I'd like you to think in that moment what is the theme tune as you enter theater? I'm not gonna ask you to say what you think yours is, but it might be something along these lines, and you go in, you take over, you get the Hemi reduced and you ask the Reg to close on your way out. You shout at the scrub nurse for calling you and interrupting your meeting and later on in the day you fill out a P B A, and you get the registrar level, too, without discussing with them. And you have a bit of a moaning session with one of your colleagues in the coffee room about the incompetence that took place today. But in reality, you started off the day being rude to that registrar in the trauma meeting because they were late to the meeting. The Reg didn't decide to call you and instead opted to try to just manage themselves and keep their head down. And after what felt like an eternity, you arrived to theater and to your registrar. Your theme tune is actually this thank you, and ultimately you walked in and you made assumptions. You missed the teaching opportunity for the registrar and you passed judgment early. And it's your incivility in this situation that has damaged patient care. It's damaged. Your reputation damaged the trainees reputation in front of the team that they're having to work with and are learning to lead. And you've disempowered not only the trainee but also the scrub nurse who had the sense to ring you when things were not going well in theater and this has all been triggered by the one Axion you made in the trauma meeting in the morning, and you set the tone for the day in that instance so we can think about situations where we're particularly at risk of this happening. And I think we've already mentioned throughout the theme of today the trauma meeting, the on call being down in a and A and sometimes fracture clinic if it's really heavy and overbooked, Oh, clinical situations that lend themselves to incivility taking over. And that's because they're high demand their higher volume, their time limited. And it's a stressful situation that brings out the worst in all of us. But actually, it's not the only place that it happens. And you can be up in the office taking a phone call from E. D. And actually, maybe even more likely to be in civil or uncivil to the people that are on the receiving end of that phone call or the nurse practitioner in the G P practice that cause you're the physio that cause you with another called called Queer Record require inner and actually we see it more and more happening in social media as well, where? Actually people are just mean to each other without even knowing them and knowing the background to those situations. So I'm going to ask you if anyone wants to chip in, why they think that being talking to someone over the phone and social media puts you at particular risk of incivility. Anybody? It's quite easy to be anonymous, isn't it? In that situation, So you're not face to face with someone. You're not there and you can hide behind either you know a false personality, or how many times have you seen that happening in front of you? I can think of plenty of times I've seen this happen, and it is, as Mike said, there is no ownership over the things that you're saying, particularly social media, so many anonymous accounts or people that you don't know. You don't necessarily have the empathy for that person and how they feel because you don't know them. There's no social responsibility to how that person feels. They're not one of your friends or family, and so you don't necessarily mind so much. If you upset that person or over the phone, they don't know who you are when you're speaking to that person in A and E. And so you feel that you can be perhaps ruder or more sarcastic over the phone to them when actually, you're in an incredibly privileged position where you are able to offer sub specialist information and advice, and you're not able to necessarily understand in the heat of that moment when you're busy and you're trying to see all of these people that actually that person asking for your help doesn't have that specialist knowledge, and you are in this privileged position, So share your knowledge. And then there's what's going on around us. So actually, on a night shift were probably more likely to be in, uh, in civil because we're tired. We've not seen our family might be away from your Children because you're on a night shift. Or maybe you've got your exam coming up and you're more stress than you usually would be. And so it's bearing in mind the context as well as where you are that makes you more likely to be at risk of being in civil. There's the non work related triggers, so I think probably all of us at some point have experienced being hangry or having lack of sleep and needing to carry on working as triggers that perhaps you're not as tolerant or as resilient. Definitely having problems financially or problems at home are going to make you less likely to continue to be civil at work because your bandwidth is occupied by these things and your own health and your own cognitive well being will often have quite a significant play on your own bandwidth. And it's a balance between identifying your potential trigger areas and recognizing the energy that you're bringing to work. And it requires reflection, which perhaps they're not all very good at doing, because maybe we don't practice it enough. But the more you practice it, the more insight you will find and the easier it will be to identify your triggers. So if we go back to how we set up that day in the trauma meeting that set the tone for the day and it sets the patient's care for the day, and often we don't necessarily relate that to the way that we behaved in that interaction. So finding out why the registrar was late well, actually, if as a consultant I had spoken to them afterwards and had said, You know, it's not like you to be late. So everything okay? I might have found out that actually, the registrars mother has been diagnosed with a terminal condition and they've been in a and e all night because they're her sole sole carer. Uh, and actually, I might say to myself, Why does it even bother me so much that this person was late? I did the meeting. The list started on time. Nothing was affected. This is just a professional behavior issue and actually in context. Why has this registrar even turn up to work today rather than it being a negative effect on their character and their reputation? So how can I prevent this in future? Well, I can gather information. I can consider my own unconscious biases that I personally No, I don't tolerate somebody being late Very well. I personally like to be early to everything that I do. But on the rare occasion I am late. I know I find it very stressful and I hate that situation. So why assume that the other person doesn't feel the same way that I do about that I consider what my bandwidth is that day. And actually, maybe on this day I had an argument with someone on the way there. Maybe there's been a problem with the car. Maybe I'd had a difficult night myself. And actually, in that moment, I can exhibit my own emotional intelligence not only to reflect on my emotions that morning, but actually to consider the registrars emotions in that situation as well. And ultimately in the similar way to talking about resilience and act therapy, creating space for those difficult conversations and actively listening is a really important skill set to have. This is a piece on Twitter from Indiana University. Please take responsibility for the energy you bring into this space. Your words matter, your behaviors matter. Our patient's and our teams matter to take a slow, deep breath and make sure your energy is in check before entering. And actually, that's just a really simple thing to do. Just have that moment to consider. You've just had an argument with somebody in A and E, and you've gone around to fracture click clerk, a patient. Just check yourself before you, then take that mood into another area and Actually, you might in that moment reflect on the way that you've spoken to that person in A and E, and you might decide that you go back and smooth things over and apologize. But also, if you're a bystander and you're seeing this behavior, you can call it out with compassion, and that is a really important skill to learn. And I think it's something that we're probably all continually learning to do. Um, this is a quote originally from Benjamin Franklin, but I think most revision hip surgeons probably live by this by failing to prepare, you are preparing to fail. So identify what your potential triggers are before they happen and plan how you're going to handle these situations. And you can consider this a talk. It, um, and things that you've got in your talk it to deal with communication issues, which is often where this manifests. Um, Mike, are you still there that you could set up the next poll for me, please? So there's accessible with you too. Uh, just get down to it. Sorry. Thank you very much. So we're going to put out another poll, and basically, I'd like to see from you guys what it is that you would think you would do while the consultant and the nurse were in that argument while you were standing there closing the wound in theater. Okay. Should be up now. You'll have to read the results for me, please. My Because I can't see the trap. You got 20 T responses so far. Okay. Where are we sitting? What would people do? Uh, we were sitting mostly remain remaining scrub and attempting to deescalate, uh, and then followed by about 39% of people saying they would stay quiet and close the wound. Nobody. And no one's on scrapping. Fine. So let's assume that you remain silent, which as much as I'd like to think I would continue to operate and try to deescalate in that position with everything that's gone on that day, I don't know whether I'd would if I'm honest, But why is it easier just to remain silent? Well, we have to reflect on the fact that we might be embarrassed. It might be perceived to be taking sides, and actually, you might deep down know that that the scrub nurse was right to call for help because you weren't, you weren't managing. It might feel like you're interfering and you might feel like you're about to become the target of that rudeness. And we know as a bystander of that rudeness that you are going to be affected by it as well as the person on the receiving end. You might feel that it's not your problem, although in this situation part of it is because you didn't call for help and you didn't explain what had happened in the morning if you felt comfortable to do so. And actually it's easier to remain silent because we're worried about security of our job and our career progression. Because, actually, maybe you need that consultant sign off to be able to progress for your ercp and so it can be easier to keep your head in the sand. And can that be a good thing? Well, if you're actively listening in that situation, you might once that once everything has called off, be able to mediate more of a conversation. But it does require active listening if that's what you're doing. But actually remaining silent is a form of avoidance, and actually we know that that can also affect civility because you are harboring animosities. So then what makes you comfortable to speak and get your head out of the sound sand? Anybody have any thoughts? I guess the culture of the department. Yeah, absolutely. It's a really big difference, isn't it? So if you feel going to be listened by that department, if that's the culture or if you feel that you're accepted by the department, you're going to be more likely to feel able to speak up. Thank you. Anything else from anyone? Um, probably fitting with that, but familiarity. So if you know the members of staff a bit better, you might feel a bit more comfortable to speak up in that situation. Yeah, absolutely big difference. Name Miguel's. So, uh, there's a couple of comments on the chat, which I know you can't see, but, uh, no repercussions towards the ercp or assessments perfect or towards their learning opportunities. It's difficult sometimes as a trainee, isn't it to be able to speak up and feel comfortable to do it? So, uh, no repercussions, I think, is quite important. And that comes back to being an open environment and a department that is has an open culture that's willing to listen, Um, and willing to make changes you might on occasion actually get invited to speak up. Um, but it doesn't necessarily make it entirely easy to do so because there's pressure for you. You may feel pressured to say certain things as opposed to what you're genuine feelings. Are we mentioned familiarity, which I think sometimes probably relates so many to acceptance as well, and how you sit in that department and how value do you feel as a member of that team? And actually, sometimes we can be empowered by rule. So actually, when there is a zero tolerance to this poor behavior, then actually we can maybe feel empowered to be able to talk about the things that have been said in a compassionate way. The language and tone that people are using might make you more comfortable to speak up so that if it's more aggressive, you may feel less likely to want to. But actually I would challenge you that in those situations in the right way, it might be even more important to speak up and ultimately being able to advocate for others and perhaps have bystander training is quite an important skill set to have in your toolkit and the biggest thing, um, personally to me, and I think in some research has been that if you know you're actively being listened to, you will be more likely to speak up. So when people are actually listening to you and really taking in what you say, what difference does that make to you as an individual? Anybody? Well, it means you more. It means you're more inclined to actually express your opinion on on something because otherwise you might think it's wasted effort if if no one's going to listen to you. But if people actually receptive and willing to take on feedback and potential improvements, then there's actually value in saying something good. Yeah, absolutely anything anyone wants to add? Yeah, When when somebody is listening. I I think that there's a dialogue then because you you you may not be entirely, you know, your your views may not be entirely worthy. You know, there might be things that you could your perceptions could be, um, slightly off. And, um, but you're not going to express your feelings freely unless you're going to be heard. And, um And then that dialogue, I think, is the most important, isn't it? Expressions Because you will read a lot about the emotions and their vulnerability from their face, not just listening to the words that they're saying. And don't just sit there planning on what your response is going to be because it can guarantee you're not listening to actually what they're trying to get across to you. The points that they're trying to make rent backwards instead of fluids. So not only do you want that from your colleagues and your peers, but actually this is an opportunity for you to have the power to give that to your colleagues and other trainees. But how does it actually change the situation? Well, in this situation, we go back by our theater case. In the trauma meeting, You would have been able to assess that what that registrar's bandwidth was for the day. They've been up all night. They're tired. They're probably still quite worried about their mom, and they probably don't want to be at work. They probably want to be with their mom, who is very unwell. And actually, in that moment, um, you will have decided hopefully that you want to be present in theater to support Trainee. You may actually, in that moment put into perspective the bad mood that you had because your partner hadn't taken the bins out was actually in relation to what that registrar going through pretty minor. And you could get on with your day and you might have reflected that. Actually, it was not the best idea to double book a meeting at the same time as a trauma list. And actually, just that element may have meant that the registrar felt comfortable to call for you themselves, as opposed to waiting to be in a state that the scrub nurse needed to intervene in theater. You might have gone in and actually asked the registrar why they were struggling. You might have found out that they only had a medical student assisting them, who had never even scrubbed before, and the registrar was having to take them through and teach them. But actually, in that moment, that registrar's bandwidth being able to deliver teaching was not there, and so you would have been able to then have not assumed that the registrar was incompetent, not have gone on to have conversations with other consultants in the department about their incompetency, but actually have empowered that registrar to train in that situation and to have helped them in a training opportunity for themselves as well as the medical student and so assessing the situation before taking over is really important. And ultimately this will have made you, in that moment an empathetic leader and hopefully as you left theater, you would have actually acknowledged and thanked the scrub nurse for helping you and the team rather than shouting at them. And so the team as a whole feels valued and heard. Hopefully everyone feels respected and supported in that environment, and it makes us more willing to help each other to collaborate and hopefully to be receptive of, of positive feedback as well as negative feedback. And ultimately, as a team, we become more productive with the main feeling that everyone is empowered to speak up. And actually it's not just those members of the team here that's been affected by that change. Now the medical student has not seen this rude behavior. The medical student may want to continue to pursue orthopedics. You have changed that medical students perception of being in theater and being a surgical trainee. So how do you consciously listen? Well, you have to receive the information, appreciate the information, summarize it, and then when it the person has stopped speaking, you can then ask questions. And actually, you might continue in that loop because once you ask questions and then you receive further information, you may continue to go round. The most important part of receiving is that you are paying attention, and you that person has your dedicated attention. And when you summarize, it's not about reflecting back what you heard. It's about reflecting back what you understood and took away from what that person has said to you, and that you only ask the questions when they finished speaking, because the worst thing when you are consciously listening is to interrupt that person's flow and guide the conversation in a way that you want to take it with your own agenda. So I was thinking about Well, how can I go about improving and building civility just into my daily practice? Okay, when was the last time you got complimented at work about the way you presented a case about the way you did a case about an interaction you had with a patient in clinic. When was the last time that you said to an S H O U did a really good job with presenting that patient today or that wound closure was great to try to validate other people because we know how we feel when we have a positive compliment. So why not give that feeling to the others around us? When was the last time you actually turned around to your consultant and said, Do you know what? I've had a great day in theater today. Thank you so much for the way you trained me. And actually, by spreading that it's contagious and you may find that it then comes back to you as well. Having a dedicate like actually showing a genuine interest in your peers lives in and outside of work. Uh, and being able to offer it your undivided attention when you're speaking to people actually goes quite a long way. And asking people their opinions on situations also helps to build trust and reliability within your teams. I think sometimes we're not so good at doing this, but actually welcoming new team members, which might be a medical student that comes to theater a couple of times, and we don't see them again, or whether we're welcoming a new trust grade doctor or at registrar change over time, just making sure that every person in the team feels welcomed and supported in that environment. But what we need to do is to stop gossiping behavior and to stop bullying behavior and occasionally consider that you might be the person that's wrong and be able to say sorry in those situations. We've heard from Mike about emotional intelligence, and I think that that really does play into your being able to build civility into your daily practice. And finally, it's not rocket sciences. These are simple things that we should be able to do day in, day out. But change isn't easy, so we should always celebrate the winds. And the process of being civil is viral, so watch it spread. And there is, um, one piece of work that said, if you're 10 ft away from someone, you should smile. And if you're 5 ft away from someone, you should say hello and actually, I experienced this up north on fellowship. Everyone generally around the hospital is far friendlier than down south. Every single person, regardless of their grade or position in the hospital, will say hello to each other in the corridor and ask how you are. And actually when you see that happening and you see the effect of that as it spreads, Um, it does change your practice. So I challenge you to the 10 5 raw and finally, hopefully this means that we can turn. This is how we do things here into a much more positive statement and my last slide. I love this quote. If you think you're too small to make an impact, go to sleep with a mosquito in the room. So hopefully, um, we've put active listening into our talk it. But some of the things that I would ask you to think about on your commute into work or while you're cooking dinner, uh, the kinds of things that will come up at some point in your training or in your consultant posts, and that's to think about when a conversation gets heated. What are you going to do in that situation? If you see someone not being civil, how do you compassionately call it out. And how do you avoid taking over conversations, regardless of whether it's something that's a high intensity conversation or if it's in civil? But how do you actually actively listen and not take over any questions from anybody? Phenomenal. Kate, I'm inspired to change. Uh, got a question from a medical student who's sitting next to me, Been listening avidly to everything and hanging on all the pearls of wisdom. Uh, genuine question. Do we get irritated by medical students? And I didn't want to give a biased response, uh, single response. So I thought, put it out to the whole crew out there. Do you get irritated by medical students at times? Can I say something? Go ahead, Tom, Go. So morning. So hi, I'm Tom Margarine, one of the spine consultants in the Norfolk and Norwich. But I'll be honest. The only real thing that irritates me about the medical students is when they come in there and they're really disengaged. If they come, they're asking questions. They want to be there, and they're paying attention. I'm perfectly happy with that. Actually, I find it a lot less annoying. The ones that annoying me the most are the ones that either you ask them something and they clearly haven't been listening or the ones that just come and sit in the corner and despite my attempts to try to engage them, and I am aware that sometimes it could be my fault that they're not engaged. But that's the They're the most frustrating times because you you just wonder, what's the point of them being in the room in the first place? If you're not going to be engaged and you don't care, does that make sense? So sitting in the corner on your phone or something like that, that really gets on my on my nerves, but actually having a medical student and especially if they're engaged, they're keen. They're asking questions. I prefer that it takes some of the tedium out of some of the clinical situations right. I'd go further to say that that's not specific to medical students. Having a show in theater that is not engaged or a registrar in theater that's not engaged are equally frustrating. So everyone says I agree with Tom completely. If I've got someone that wants to be there in theater, that's the best feeling even better, Kate. Even bigger. The whole team, your whole staff, you know, like I start the morning off with the team brief. I get them all to contribute a little quick to the question each, you know, and get them so they understand what we're doing. Why we're doing it. You know, maybe show them a video of what the procedure is going to be, Um, and the honest it's the The feedback is great. They want to do better. Uh, so you're right. And, uh, Tom, uh, completely agree. Disengagement is the most off putting thing, but maybe that's something that we can work on to get them engaged. And as Kate has said, I'm going to I'm going to try to address my behaviors, too. Medical students. Okay, so I'm gonna you'll be noticing a change soon. Um, I'll be quite frank. They are in the way. Um, um our utilitarian aim in most situations is to get the most patient's seen or done, um, as we can. And anybody who interferes with that and has the audacity to ask to belong and to be taught gets in the way. Um and that's a fault of the system, and it's a fault of people like me who aren't ready able to adapt to it. Um, some people enjoy it. Um um, Now, one way we could do that is that there are medical students. Just don't go to people who aren't good at teaching them. But how would a student know that, You know, until they until they turn up and get a cold shoulder. Um, yeah, I'm afraid they are in the way. They do slow us down, but that's a fault in the system. And personally, I'm going to try. And you've already had a massive effect, Kate, but like, thank you for your honesty called it because I think it's a difficult thing to acknowledge and have insight of our own skill set of what our bandwidth is in theater. And it does come back down to a bandwidth, isn't it? You're focusing on the task at hand the pressures of the management to get those cases done, the pressure of knowing how many trauma patient's there are on that waiting list that if you get one case less done, that is one person with a broken bone that's waiting to be fixed So it's understanding the pressures of the system that we're working within and what our own personal bandwidth is and, you know, kudos to you for recognizing that is the first thing I think, because I think a lot of people don't. And I think, actually, would it be fair? I'm going to put this out there to say, Actually, that doesn't just stop at medical students, So sometimes we might be better at training registrars. But actually, there are plenty of consultants out there who actually aren't interested in training registrars but have registrars attached to them. At what point do we say I'm not a trainer, I will provide service provision, and I will give the time to those that are willing and are good at training to train something that's come up there. What about if we set the expectations with a like A? I know that one of the train consultants that think Ipswich provides a, um, a kind of glossary of what his likes and dislikes are aren't and it helps. I think that's really useful. I think, you know, setting the expectations right from the off and it kind of reaches out to what Tom was saying, You know, I want engagement. You know, if if you want engagement, then if the medical students, anyone else, the registrars, healthcare professionals know that, then they'll probably be more with that. So maybe if we if we are more open as what do we expect? What do we want? And if we set the stall out like that, I don't know how how many trainers interact with I s e P and have their own trainer portfolio set up so that trainees can see what we like before they even come to us. And then I would put to the trainees how many of you have actually look to see if your consultants have completed their trainee trainer portfolio on ICP? I didn't even know that was the thing. It's been recently on both sides of that coin. Okay, so, yeah, So the trainees check out your trainers portfolio on ICP, and if they don't have one, encourage them to or perhaps even help them fill it out for the next trainee. That's coming along after you. If you know that there is something very specific that that trainer likes. Lovely. Uh, sorry, Tom. I did realize that I just looked at the program and I jumped in your slot. So, Mr Margera, um uh, to talk about conflict resolution and de escalation, which hopefully leads on maybe a bit better order. That's going to be what I say. So I have uploaded slide. Uh, right. Um, so this is, um, the conflict resolution and de escalation tool. Now, I'm hoping that I didn't invited to do this because I have been the source of much conflict. But we'll, um, we'll take that with a pinch of salt for now. Um, so first off, conflict definition, Essentially, when there are two parties, it doesn't have to be people. It can be groups of people that have some kind of unresolved differences. Um, and that unresolved differences can cause conflict. Now, they don't always have to be really unresolved differences and always have to be something powerful. That can just be a perception of different differing approaches or styles to doing something. Um and and and sometimes you can be doing things exactly the same as someone else, but but still, there could be a perception of conflicts. And so that's something to bear in mind or they're obviously much more difficult to deal with but easier to solve. Um, conflict is traditionally a pretty negative term. I think everyone on the chat would probably, um, sort of say that conflict is a bad thing. But in preparing for this, I went through a whole load of stuff. And actually, there are quite a few examples where conflict can result in a force for good, especially if it's managed correctly. Um, does anyone have any, uh, sort of examples of where they think that might be the case? Can anyone think of anything? Nothing in the chat, either? Okay, Um, well, I'll give you an example a bit later on anyway. But the the best example is when the source of the conflict can highlight problems within a system or problems, um, that people weren't necessarily aware of, and as a result, there's sorting that conflict out, actually deals with the problem in the system and stops anything from happening in the future. So that's one good outcome of a conflict resolution, and and we'll see some others going forward later on. So I'm not going to dwell on that too much. I just wanted to introduce the idea. So if conflict can be a good thing, um and conflict is inevitable, I would argue with in life and definitely within medicine. Why do we need to do anything about it? Why resolve it? Um, why don't we just accept that it exists that we can't get on with everyone and take a very passive approach to it? Well, there are some, of course, downsides to conflicts as well, so it kind of everyone will see that it Kate's last talk is a good example of that. The conflict and arguments, especially in front of other people, can cause quite a lot of disengagement. Um, and it can affect people that you wouldn't necessarily think it would affect as well, so it doesn't necessarily have to affect just you or even your immediate team. There can be other people that you might think it would affect. And I'll give you an example of this. Um, I don't think it's any particular surprise to know that, um, the spine team and Knowledge has has some conflicts within it recently, which has resulted in the departure of one of the consultants. Although it wasn't directly as a result of that conflict. But because of the conflict between these two factions, there's, um there's a secretary that was working for one of the consultants and secretaries working for the others, and even the secretary that was working for the consultant felt as though even though no one else felt it was the same. She felt just simply by being associated with the consultant at the center of this conflict that she was also involved and disenfranchised and in fact, quit. She worked in the NHS for 18 years, ever since she was 18, and she quit her job and moved to a different A completely left healthcare went into a different environment simply because she was involved indirectly in this conflict. So we do have to bear in mind that it does involve people other than ourselves and the much wider team, and that's another real big reason why we need to get on top of conflict and get it resolved. It can, of course, cause cause be a really big source of resentment within teams and different people causing divisions, factions, Um uh, and then you start to get into the question of loyalties, and that can have a massive impact on teams and working relationships. Um, and once you start to have those impacts, inefficiencies start to creep in. People start to make decisions. That might not be the right decision just because it's a different decision than the other person made, and you get in this whole vicious spiral of things becoming less efficient and even unsafe. Um, workplace stress is another big thing. Working in the NHS is stressful enough despite having to come to work, dreading bumping into Mr so and so or dreading having to talk to Mrs so and so today. And actually, I think conflicts can really escalate workplace stress, which is already quite high sometimes. And another, therefore, good reason why conflict needs addressing, um, we touched on poor decision making as a result. But once you start to bring the emotions of conflict into decision making as well, it can really cause ill judgment, and people can make some really sort of not sensible decisions. But as I said and I sort of highlight this again, um, it can be a source for good so it can cause, uh, innovation. It can cause people to start to think outside of the box because they don't believe that they have to think in the same way as the other person that they're in conflict or the other group that they're in conflict with. It can highlight shortfalls in a system So, uh, so they can be addressed. And it's actually quite good at engaging neutral people. So, um, we'll see later on about how people try to resolve conflicts. But often, um, there are when there are too polarized parties, you can find that a neutral party may become involved in something in which they wouldn't have been involved. And within a team, sometimes that can be really engaging for people in the team who might not have been engaged before, Um and then with good resolution of conflicts, um, and being honest with each other about our shortfalls and, uh, the way we so the things we like and dislike about the way other people have done things it can really, really bring a culture of open honesty and sometimes develop even trust if you manage it well. So conflict in itself can be a bad thing because of all of those reasons. But there are some good things that can come out of the end of the conflict if it is managed well. And if we approach it in the right way, I'm going to split it, split the next section up into conflict with patient's and conflict between colleagues or other people that you work with. And that's because of the relationship with colleagues. And patient's is very different. Um, the themes are the same, but But I've split it up because I think that's an important thing to do. So we'll start with colleagues so sources of conflict in a colleague. So we obviously we've got resource conflicts. So I want this, but you're using it kind of thing. Um, interestingly, my two year old and four year old have the same kind of conflicts on a regular basis. That's mine. I want it. But nevertheless, it still feeds down. It still feeds down into surgeons as well. Uh, and so resource conflicts is a big thing. Um, the next is, uh, sort of seems fairly obvious. Goal incompatibility. I I'd like this is my aim for for whatever we're doing. But your aim is different, and therefore we're sometimes pulling in different directions. We may even be pulling in very similar and even the same direction. But just because we have a different idea as to where we're going that can sometimes lead to conflict, even though we could easily both achieve our goals by working together and doing the same thing. And then, of course, we've got the different personalities, ideas and beliefs. So, um, these will come through into sort of personality, in my opinion. But sometimes you just don't get on with someone else. It doesn't matter how hard you try. It doesn't matter. Um, anything else. People don't get on, and often there's a lot of, uh, there's a lot of neutrality in this, So we should often people feel that we should just accept that and and move on. And the trouble with that is, if you don't address such things and, uh, and learn to work around them, then, uh, that can start to breed a bit of dis resentment, a bit of resentment and a bit of disengagement from the wider team. And you'd be surprised how sensitive the team and different team members can be to sort of an undertone of personality clashes. And so I'd counsel that just accepting it and moving on should be your last resort. Really? Um, sometimes it might well be the only thing that you can do. But I would counsel that. That should be your last resort. And you should really, um, at least try to resolve such issues. Communication is, um, uh is the source of all problems in the NHS. It would seem, um, usually lack thereof or miscommunication. And, um, you don't really need me to explain why that would be the case. Um, the final thing is inflexibility. So, um, this kind of goes up with resource conflict and the goal incompatibility really, isn't it? Um, being able to adjust and work around different things is one thing that we all think we're good at. But actually, that kind of inflexibility can be a real source of conflict, especially when you're in a stressful situation and you start to bring emotions into things. So inflexibility another source of conflict. So what are the goals of? So we've spoken about what the sources of conflict are. We've decided that resolution of conflicts can number one stop the bad things from happening, but also number two lead to those good things that I previously mentioned. But what are the what are the goals? What are we trying to do from resolving the conflict? So what? The the key sort of resolution aim is to leave the conflict in a better place than when you start. You started it, and that might seem really obvious thing. But often you'll find, especially with emotional conflict, that both parties leave in a much worse place than when they started, and the whole process leaves a very sour taste. And so, um, focusing on leaving in a better place than when you started is actually not as stupid a suggestion as it sounds, and you'll see a little bit later on about the different methods that we can use to do that. Um, of course, maintaining professional respect. And that's not necessarily maintaining the professional respect between the two parties involved in the conflict, but also maintaining the professional respect of those witnessing and being involved around the peripheries of the conflict. The one of the one of the most rapid ways to lose your respect of your colleagues is to behave poorly in a conflict, allow your emotions to get the better of you and, um, start making the wrong decisions. And I would counsel you that it's not really the respect of the person you're arguing with or in conflict with or the other team that you're in conflict with. That's the the respect that you lose the most. Actually, it's the onlookers, the bystanders, the people witnessing around the fringes of the conflict there, the people that really have much more objective view of what you're doing or not doing, and that can result in a massive loss of professional respect from the wider team. And so I would counsel you to be mindful of that when, especially if these things are happening in front of other people. Um, so we will see about the methods of resolving conflicts and how removing emotion from that can be a really big thing. But you need to remove the emotional responses and the stress from the situation to be able to to leave the conflict in a better place than when you started. If you started, if you leave a conflict still angry and, um, with lots of emotion, number one, you're almost certainly not going to have achieved anything. Uh, and number two. That anger and resentment will continue to bubble away on the on the underneath and you'll find it results in more conflict or the conflict hasn't really been resolved and it will continue. And then the final thing, really, And this might seem like the most again obvious way to resolve a conflict is to reach a common understanding and a way to move forward. But you'd be surprised, I think, if you really took a step back and and witnessed conflict between colleagues I'm talking about now, not necessarily between patient's about about how poorly we can achieve this. So, um, sometimes people just want to get away from each other, in which case there's no resolution there. Sometimes it's a lose lose situation where no one gets what they want. Um uh. Sometimes it can just simply be one person enforcing there will or or shouting louder or whatever it might be. Or I'm more senior than you or whichever sort of root they take. But then you get someone winning and someone losing it, which again is not a common understanding in a way to move forward. Um, it might well resolve the conflict at that time. But it is not a common understanding. It's not a compromise. It is one person winning and one person losing, which is equally a poor, a poor outcome for conflict resolution. So who should Who should be the ones to, uh, to to solve a conflict? Now, when I This is just the order that I put them in, um, in my own head, Uh, from what I I thought, And then, actually, we'll see how that's probably not the right order. Um, so the first person is the leader of the team, whoever that might be. So, for instance, a team of consultants. If there's significant conflict, you might I might involve my clinical leader who I wrote might be my manager, um, to try to come and help resolve said conflict. Um, and, uh, that leader of the team should possess the all, uh, the correct skills. And often, actually, that is quite a common way that people do go about resolving conflicts. So, uh, person a doesn't like person be. They have an argument about something where there's some kind of conflict that I want to use this and you're using it kind of thing The first thing they'll do is escalate it up the tree and find someone else to make a decision for them. The trouble with that is so Number one, um, it doesn't sort of so. Number one. There's no mutual understanding. There's no communication between the two parties, and also it doesn't take any emotion. Out of the situation breeds resentment. Number two. It relies on the leader being good at solving the problem. Okay, And number three, it often results in one person winning and one person losing. Because inevitably, that leader will end up choosing a side of some description. Um uh, and, uh, and as a result, it's not particularly greatly to resolve conflict. Um, another thing that I mentioned earlier was the neutral party. So you see, two people argue. So, for instance, two of my colleagues are arguing in the office. Um, I might, as a neutral party, step in to try to mediate things and calm things down. Um, that might work for a bit, um, and it might be a reasonable way of doing it, and as I said, it's one of the good ways of engaging on the members of the team so myself as a neutral party. Now I can get involved in solving this problem. And, you know, I have three heads instead of two. Um, but it does involve often, um, that neutral party then having to take aside or something like that. And it is quite difficult to be a neutral party in a conflict and maintain the respect of both parties so it can just breed more conflict. If you're not careful. What I should have done is, uh, put this involved party people right at the top of that list. So the best people to resolve the conflict are the people involved in the conflict. Okay, if you can resolve your if you can demonstrate the emotional maturity, the professional maturity and the self awareness to, um, resolve your own conflicts, that is by far the best way. With the best outcome, you'll maintain the professional respect of the other party, most likely, but also of the surrounding colleagues. You don't need to drag other people into the argument. Um, and it is by far the best way to resolve a conflict. And then finally, we have mediation, which is kind of the same thing is going to. You're going to the boss and asking them to sort it out. But you'd be surprised how far these things can go and how much official mediation is needed. But it is always there if conflicts really cannot be resolved by any of these other means. I thought it was worth mentioning to make everyone aware that it is a final option. Um, but it is not a pleasant option. And I would counsel it, trying to get everything sorted way, way before you you reach that point would be the best way. So different methods of resolving conflicts. So the first is you can withdraw. And we all like to think that we don't do this. I probably do it more. In all honesty, I'm not a particular fan of conflict. I probably do this more than more than I should. You can withdraw you can. Someone says I want this and I would say, You know what? I can probably live without it. You can have it. Um, that can often be quite lose, lose or or can end up in a short lift, short lived resolution. So all that happens with that is, um next time the same conflict will happen the next time That piece of equipment needs to be used. Um, it can be a really tempting option, and it can de escalate a situation really quickly. But does it really solve the underlying conflict? Um, maybe if it's, uh, if it's something very simple, but it can lead to undertone of resentment. And also, sometimes when someone feels like they're winning, um, they can become, then empowered to cause more conflicts as well. Which is what, Kate? The exact reverse of what Kate was saying in the last two. Or, you know, being happy and saying hello to people spreads. So does if someone's winning and feels as though conflict is beneficial for them. They are then more likely to enter into further conflict. Um, so the next one is very always, um, sort of result in the right outcome, especially if you're, uh if you're not sort of reaching any kind of compromise compromise. Being the next thing can be can be the best of both worlds, but it can also, as we well know, be the worst of all worlds. Okay, so compromise a bit of give and take on the face of it can be can be the best thing. But if it can also result in no one getting what they want and that can be a real big problem, too. So, um, both people leaving the conflict feeling unsatisfactory can affect morale and is therefore not quite the same as the last way, which is to, um, to nurture the confrontation and change it into a collaboration. So rather than fearing the confrontation and withdrawing rather than one person dominating the argument and the other not rather than even compromising so say, Well, I want this. You want this? Let's ni reverse have it. That would be a lose lose situation. Um, it would be a collaboration. So, for instance, um, you could, with the appropriate skills and with a mature attitude removing some of the emotion out of the situation Um, you could say, for instance, actually, you want this, um, you have it first, and I'll have it. Second, I'll change the order of my list or something like that. Okay, These are just very simple examples, obviously, but that collaboration or confrontation would be a really good way to get around it. And you could even take that a step further. Well, actually, you want this, and I want this, but we've only got one. Maybe maybe we could have to. Maybe we could get another one. Okay. And then? And that starts to resolve some of the issues in the in the resource conflicts. Uh, and actually, then the system becomes better. Okay, so they're dealing with the confrontation. Collaborating and reaching a shared understanding. It done in the right way can lead to both parties working towards a positive change rather than one person winning or losing, or no one winning. Does that make sense? It's quite, uh, I try to explain that through those weights, because it flows quite nicely that way. Um, I do understand that the lines between these things can be very great, and it is a skilled that's difficult to masters, But it's not necessarily, um, it's not necessarily a source for bad conflict. And in fact, confrontation and collaboration can lead to a positive outcome for everyone and make the system better. So we're just going to dwell on confrontation and collaboration a bit better. So listen so different ways to achieve this. The skills that you need to be able to do these things. So the first thing that you if you read any of the confrontation books or any of the previous lectures from so called experts is listening is key. Okay, an active listening. So this comes back to what we're staying with the medical students and becoming disengaged. Being disengaged can be just as frustrating and annoying as as standing up and shouting at so so not paying attention. It's just as bad sometimes. So it needs. It needs to be some kind of active listening. Um, And by engaging by listening, um, you might even be able to realize that idea. You might just be wrong, of course. Or that you're actually these problems are surmountable, and we can collaborate and work together or that app. Actually, we're not. We're arguing, but we're both want the same thing. Uh, in fact, we're arguing for no reason, and there are definitely good things about that. But listening also, what it does is it starts to deescalate the emotions out of a situation, and it allows your colleague to, uh, feel respected. And we spoke about that before. Okay, um then you need to acknowledge both your emotions and there's and try to park them to one side. There's no point continuing down this pathway if you're both still angry, Um, and the emotions can't be de escalated. And that might even mean that you have to come back at a separate city and sort this out. Um, but high emotional states, which is, you know, dealing because of the stress and because of what can be at stake with some of these decisions, high emotional stress can be a problem. But you do have to try to mitigate that as much as possible. Um, then isn't so. Our colleagues are important, and we do need to maintain the relationship between our colleagues and one really good way to mess that up really quickly is to start making personal comments. Okay, so, um, the conflict has to be about the situation. Try to remove the personalities from it, use your emotional intelligence, which you've already had some talks on. So I'm not going to as well on, um, concentrate on the facts of the situation rather than, um, belittling everyone, belittling the other people's opinions, focus on the facts and try to move forward rather than becoming personal and and using it as an attack. Okay, outscoring points. Then peel back the roots, get to the peel back the layers to get to the roots of the conflict. Just you may even have to work from the bottom up, and it may may be a bit of a battle to get there. Um, but putting a sticky so putting a sticky plaster over over something that's just come to a head But not solving the underlying problems is just going to lead to those problems coming to, uh, up later. So, for instance, again, I go back to my share ing of things that I want this you wanted, Um, changing the order of the list and working together might well be a good way to deal with it that day. But it's there's going to be more problems in the future, working together to get a second bit of kit so we can both do what we want whenever we want would be a much better way to do that. And rather than just putting a sticky plaster over this occasion, All right. Um, obviously, we've spoken about the common goals before Um, honestly, it's a big thing. Um, so, uh, in the heat of the moment, we all say things that we regret or promise to do things that we're not going to do. But in conflict that's especially important, because in order to maintain the trust of the other party, that you're involved in the conflict and you do need to follow through with what you're doing. And be honest, there's no point, um, lying, making things up, it'll just come out back to bite you in the end. Um, and then we've talking about We've spoken about collaboration already, and escalation to senior people should really be a last resort. It shouldn't be the first thing that happens. Uh, and it can lead to a quite forced outcome. It can lead to resentment and side taking. And, uh, to be honest, we're all adults. We're all mature. We should be able to at least start to try to resolve our own conflicts in the majority of cases. Although I do appreciate that not always is that possible. Um, and then we just need to be mindful, and I put this last one in because I think it's really important professional and personal relationships are not the same thing. Being able to professionally work with someone have a good professional respect with someone is not the same thing as having a good personal relationship with them. They often do go hand in hand, and it's much easier to have a good professional relationship with someone if you have a good personal relationship. But having professional respect and having a good personal relationship and not the same thing, you might just have to bear that at the back of your mind as well. So having said that, leaders shouldn't really be involved in sorting out conflict in the ideal world, we all know that they are, and we are going to have to, um, to learn to to be leaders. Most of the people on here registrars, you want to be consultants and most of you will be, and as a result, people from your team will come to you with various examples of conflict that you need to result. Um, so we've spoken about acknowledging the emotions and deescalating them. Removing the emotion from the situation is probably the biggest thing you can do to allow the rest of this to happen, concentrating on maintaining an environment of respect for each other and for both parties. Um, the enforce listening is not quite as nice as active listening, but sometimes you do have to, uh, one of my colleagues comes to mind who's who talks over people all the time. Sometimes you do just have to say, Look, you will get your chance. Please, can you listen for a minute? And sometimes you do just have to do that. Okay? It's not ideal, but you do. Um, blaming accusations are always a source for further conflict. So really, I would, um, rather than so when you're getting to the roots of a problem, try not to have a culture of blame around that more. Just try to establish the facts of the situation and then work forward from that. There's no point pretending that there are disagreements, and trying to focus on all the good things and how you get along with each other is not going to solve the problem, because that's not the issue. So you do need to take the bull by the horns, sometimes address and acknowledge the disagreements, and then work towards solving them. Um try not to take sides. That goes without saying when you're a team leader, although it can be very difficult to do. And then we've spoken about the difference between collaboration and, uh, compromise. So a collaborative resolution rather than reaching a compromise, you'll see it says there. So try to get people working together to solve the problem for the longer term, rather than sticking a sticky plaster and having a lose lose situation. Um, And then at the end, as as I said all the way through this, you can generate some positivity from the conflict. So sometimes it can lead to benefits in the system as we've gone through all the way through. So I would try to finish on a high if I so if I am a leader and I'm trying to resolve conflict highlight at the end. The positivity that is coming out come out of this often. There can be some really good ideas if people just take some, take some time to think about things, um, and agree on a way to move forward, um, and use the positivity from the conflict. So that's a colleague conflict. We'll move on to patient in a minute, but I think they're very two very different things. And I was wondering if anyone had any questions about colleague conflicts before I move on. I've probably had a bit too much of it for the first year and a half of being a consultant, to be honest, but nothing in the chat. And no one's speaking, so that's fine. So we'll move on to patient conflict. So this will probably all of you will be a bit more familiar with. And I'm sorry. Higa. Does anyone know of a non Klay key department where different types of individuals go on nicely? Uh uh uh. Honest answer. I don't call. People have, uh I've not yet. So even in departments where it seems on the outside, like people get on, there's always factions and people not going on. Um, but that doesn't mean they don't have respect for each other. Um, I don't know if anyone else does, but I sometimes think that clicks are the only place where people get on nicely. You know, where they exclude everyone else? Um, they're not nice places to be. And I'm not saying that they're good places, but whereas a bit of what? From echoing what you're saying, A bit of conflict seems to be healthier. Okay, I agree. Okay, So your back off know going to say that? I think, um, you know, every department is different, isn't it? And this is part of the beauty of being a registrar and a training environment where you get to rotate through different departments. And hopefully you do see ones that work well together and are respectful, regardless of actually, if everyone is a personal, they may not be a personal friend outside of work, but as long as we can respect one another in the workplace, Um, And hopefully when you're if you're wanting to stay in region, you find a department that actually fits with your personality where you are welcomed and accepted. But I think, um, the point made about Clicky nous is a very valid point. And it's something that, actually I think you see, uh, that filters into even our specialist society meetings. And of course, Mr Qiang, of course, reassures us that Cambridge is a non clicky department where everyone gets on my sleep. So yeah, yeah. Um okay, So we're going to patient conflict. Now, this is your everyone to be a lot more familiar with this. So I thought, rather than going through conflict all over again, I'm just going to give you a little tool. That sort of works for me. I don't think I sort of sit down and officially go through this in my mind and saying, Have we done this? But actually, it's not a bad starting point. Um, again, Patient conflict, as much as we all like to believe were brilliant communicators and our patient's love us, we won't get on with every patient. And that is, um the way it's got to be. The key is to not let that conflict, um, get number one, get in the way of the decisions that we make. But number two, uh, to try to turn that conflict into a positive outcome for both you and the patient rather than, uh, simply saying I can't get on with this person. Go and see someone else or something like that. So again, listening top of the list. So, um, it's called the lean method. So active listening, so not sitting there disengage. And when there's a patient that you feel that you're at conflict with, you will have to make more efforts with your active listening skills. So rather than just sort of casually sitting there, uh, you know, leaning back with your arms crossed, you'll have to start adopting open postures. You have to really start paying attention. Looking at them in the I don't turn around to look at your computer. Don't start looking at their scans, all of those things. They want to be heard, and they want you to be paying attention to them. And if you don't do that, you will not win them over. So that is number one active listening. Probably the most important thing going with that really is developing some empathy for the for the patient. Okay, so coming to hospital, lots of people get worked up. It can be a source of great anxiety. They don't know what they're going to be told. They don't know whether they're going to have good news. Bad news. They don't know whether there's going to be a solution for this thing. They've been suffering from, um, people. People get really anxious coming around hospital, and it's important to empathize with that. Um and sometimes that empathy. So there's a sort of there's a temptation to say I know how you feel. Actually, some put the best patient's the best patient empathy is sometimes to acknowledge. Look, this must be really difficult for you. I can't even imagine how you must feel. That's a much better phrase, or I I really don't know how you feel, but I can imagine it must be very difficult. That's the kind of phrase that Utah talking about, rather than saying, Oh, I know how you feel that because often you don't. You're not the one going through this. You haven't had years of pain or you haven't just been told you got cancer all of those kind of things. So sometimes you do have to sort of acknowledge that you can't possibly know how they feel, And, uh, patient's do actually respond to that a lot better. Um and then So if there is conflict, um, and it might well be around the situation. Try not to make excuses. Okay, so but try to explain, so explanations and excuses are very subtly different. Say, look, I'm not You can even say I'm not trying to make excuses for either this might have happened. But if I can explain to you why the processes that I've led to it, at least we can understand what's going on. And perhaps we can understand how we can change that or how we can work together, going forwards and just being open and honest about that. But making excuses? Try, um, there's a really, um there's a real, uh, sort of fear and undertone of some patient's about, um, the old fashioned sort of way doctors used to be of covering things up of trying to make people do what they want to do or having their own, um, sort of underlying motivations and some patient's you do just need to sit down and explain. Look, none of those things are the the reason these aren't excuses. But this Let me just explain why we've come to this point and how we've got that or why we can't move forward from that in the way that you want. Um, try not to shut down concerns, but but try not to criticize other people as well. So really, what I'm talking about, um, is if people come to you with a concern about a colleague or concern about someone else or or or a concern about the cyst. Um, it's really difficult not to criticize the system and say or or your colleague and say, Oh, yeah, Mr So and so he's He's rubbish. I can I can understand why you'd think that way, Um, in an attempt to try to deescalate the conversation. What you actually want to be doing is sort of avoiding commenting on those kind of things. But not shutting down the concerns, perhaps even say, Look, I'll note down your concerns. I'll raise them with the appropriate person. Or here's the Here's the way you can raise your concerns if you don't want to do that yourself. But to simply shut them down or to criticize colleagues is not professional. Okay? And then So the end in lean is negotiation. Okay, which could be collaboration to, um, is agree on a solution. Agree on a way to move forwards, so don't just acknowledge it. Don't just listen and empathize, but you have to Then take take that forward and come to some way that you're going to move forward with the rest of their care. Okay, Um And that doesn't mean promising things that you can't promise it doesn't I mean, offering things that are outside of your power or promising You'll get someone else to do something. Be honest with what you can and you can't do. Be honest with what? What the way you can move things forward but don't promise things that you can't offer because all that does is it breaks down any trust that you might have by doing those previous three things. Um, and you'll just create more conflict going forward or conflict with someone else, and that is not anyone's best interest. Um, so that is sort of my take on how to deal with patient conflict. The listening, uh, and the empathy are probably the most important things. The explanation can be easy and tricky or tricky, and but that moving forward is really vital at the end. Uh, but please don't promise things that you can't deliver and that, uh, there's nothing more annoying than when you you've seen someone and they said, are so and so as promised. You're going to do this and and you can't deliver it as a as a and that's really not good for the patient, either. Um, I'll give you an example, and sometimes you. So sometimes you do have to create conflict to solve these things. So I'll give you an example. I had a patient who's been quite a long way around the houses, and, uh, he'd been to pain team. He's been to various other people. And, um, he came to my clinics being told that he needed an operation by someone who was to a surgeon. Um, and the the biggest issue with that is he didn't need the operation. That would have been very easy if he did, but because I could just agree. But he he didn't. And then, um, we get through to, um he he had some unusual health beliefs. But that's, um that's fine, but it became a very emotive situation very quickly when I told him there was nothing I could do, um, with leading to accusations of you don't want to do this because you're trying to save money through to, um, it's because of my mental health problems you don't want you don't want to operate on me and all of these other things, and sometimes you just have to listen to those things, but at the same time, you can't let them just keep ranting and ranting and renting forever. You do have to show shut them down, um, and explain things too. So there is some role for being assertive. Inpatient conflict as well. Okay, especially, uh, especially once you've given a chance to the other things. Okay, so there is some role for assertion in the middle there, which I think is where this method does fall down. Elizabeth, Um, that's really the end of my talk. Really? That's quite the trouble with conflict is, I think, um, it's it's all well and good talking through all of these things. But all of the other things that you've spoken about today, the emotional intelligence and all of those kind of communication skills and things really come into play. Um, but you you have to judge each situation on who you're dealing with you, your own thoughts and feelings and the situation itself. Um and so to have one method that solves all is absolutely impossible. It's a skill that you develop. It's not something that you always have to be very good at, right from the start. Some people believe they're better than others, and they're usually the people that overpower other people, to be honest. But resolving conflict is not a one way street. If you resolve it well, both people can benefit. Thank you so much, Tom. That was great. Um, any questions from any of the trainees or any experiences that anyone would like to bring up or how they might have managed things or how we might have managed the situations. And then I think she was talking about another one. Oh. Oh, yeah. Okay, fine. There's a question Tom for you in the chat. How do you introduce a chaperone in the midst of a conflict? Assuming you didn't have one to start with? Actually, that's a really good question, Iggy. The that can. So that can go one of two ways, can't it? So it can add a neutral party that can deescalate the situation. But more than likely, my experience of people that have tried to do that is, um it just escalates things, and it starts to become a little bit accusation. Ori, Um and that's a real big problem, isn't it? Because having a chaperone, um, when things are escalating so rapidly might seem like a really good idea. Now, of course, the answer is, maybe you should have a chaperone at the start, but that's not always possible. And we know we definitely know that. Um, my take on it is actually, if if emotions are getting that high and you know a chaperone might well, we need it, then probably a better off to say, Look, this is clearly clearly we're not winning with this consultation here. Um, emotions are high. Let's just have a couple of minutes for ourselves to, um, for things to settle down. And perhaps this would be better if we had someone else involved. Or at least you felt more supported by one of our other members of staff and try to make it a positive experience for the patient rather than a defensive move. Does that make sense because it can feel like a very defensive move? Um, I don't have a I don't have a magic answer for that, and maybe someone else has a better way of dealing with it. But that's the way I would go about it. I don't think that's good advice, Tom. Any other questions. Fabulous. Thank you, Tom. Thank you. And this isn't going to be the start of lots of conflicts with me. Not, but it's about forming a Okay, Right. So thanks, Kate. Uh, this talk is really Yeah. So enough of my mem mem to hopefully you heard Antihero by Taylor Swift. Think a very topical song about impostor syndrome. But as you saw from my title, it's not just about impostor syndrome. It's also about the other end of the scale and the Icarus syndrome as well. Um, so I do have a little bit of imposter syndrome. Um, here you can see in the photograph my beloved colleagues that South African trauma warrior, BBC personality, Surgeon of the year, as you may have caught last week, uh, and then next behind him is Graham Tilly strong the arthroscopic assess. Fasten as the American surgeons know him, you know, anywhere you can you can get a camera into. He's able to, uh, solve a problem surgically with it. He so I'm in a really good you know, unit. However, I am only the corner shop kid Kang's, uh, from Broome. And, uh so I sometimes feel a little bit kind of, uh, you know that I've got imposter syndrome. I wonder if how many of you might have a degree of imposter syndrome? So what I'd like to do is start running the polls. So first question, if you could put that up for us, please, Kate. Yep. So do you. Yep. Do you worry? Others will find out you are not as clever as they think you are. Um, definitely one that I fear. Yeah. So I've got 15 responses so far. Okay? There's 30 people signed in. Come on, guys. And girls and girls. Guys in the generic term. Sorry. Uh, there's 72% saying yes, they do. And that's with 18 responses. Okay, So what I'd say is, um if you this is not a full survey. But if you know, if you just keep an idea of how many you respond yes. To then, uh, out of the eight. Then, uh, we'll give you an idea of how much you might be on that spectrum. So the second question is, do you avoid challenges because of self doubt? I don't think I do. I think I like a challenge. So, uh, even if I'm, you know, not necessarily got the skill set. I would go for that. But I wonder how How you would all fair on that question and I can see that there's it's quite close, isn't it? 60 60 40. So many people are worried about the challenges for a self doubt. Third question. Do you believe your accomplishments are so or even closer? 50 50? Yeah. Do you hate making mistakes and being underprepared? Think Kate already said that she loves to be prepared and, you know, I love to try and be prepared. I don't mind making the mistakes, though. I'm okay making mistakes, so I probably aren't know to that one. Um, yeah, being a little bit underprepared I'm okay with because I think it just leaves that kind of ability to be spontaneous. But I know that some people really don't like that. Oh, wow. 94%. That's amazing. Okay. Are you crushed by constructive criticism? Um, now, having had criticism and most of it being constructive, most of my career, uh, 10 years into a consultant and I still getting it every single day. I think I've got used to it, so no, I'm not as sensitive to it myself, but I can imagine a few years ago I was devastated. It would probably be the term. Uh, okay, that's good to see. So it's a Most people are okay by with a bit of criticism, nearly there. Six number six is success, followed by a sense that you have fooled people this time. But you may not be so lucky next time. Um, yeah. Once again, uh, sometimes have it, but most of the time I don't. So I think it's I think it's one of these things that may be, may be reflecting upon it. I'm not as imposture re as I used to be. And that's a bit of a split again, isn't it? It's, uh, 50 50. Almost penultimate question. Do you assume others are smarter and more capable than you? Yeah, clearly. You know, got Lee and Graham and then cold, deep. You know, for the Pedes. I've got, uh, Joel, Stephen McDonnell and almond members a day for the knees. Got Vikas Uh, Sunil Kumar, Gram keen for the hips. You know what? What? Who am I, Uh, sorry. What was the school and that? Yeah, most of you think someone smarter than you do, You live in fear of being found out. Now I'm all right. I think I'm I'm comfortable with people knowing that I'm not the best. And I'm not the greatest. And I'm just kneel. Um, I wonder how you guys feel. Uh, sorry. It's just come up, has it. So Okay, yeah. Most of you are comfortable in your own skin, so to speak. So what is the aim of this talk? Well, it's not to find out what the scientific meaning and prevalence of imposter phenomenon is or to cure you at all. I do not have those skills. Uh, that might just be my impostors. And maybe I do have the skills there. I don't, but it is to demonstrate that you are not alone. And hopefully that little quiz has has cleared that up. That you know, there's lots of us who have a little bit of the impostor syndrome where we doubt ourselves, uh, and and think we're a phony and afraid that we're going to be found out at any moment in time and it chance to think about the spectrum of it. It's because it's not just a black and white thing. You don't either have it or not. Have it, Uh, and you know, there are the other side of it as well The Icarus phenomenon which will touch upon at the end of the talk. And then a couple of suggestions on how to harness your imposter syndrome or how to tame your Icarus phenomenon, uh, sign posts you to the relevant resources. So this is the beginning of your transformation into an orthopedic swan. I don't expect you to remember the impostor cycle. It's not like the Krebs cycle. I don't want you to be able to pull this out in the exam, But what you can see is that this has been studied significantly by, uh uh, someone called Pam Plants and her colleague Susan IMEs back in 1985. They're the ones who coined imposter, phenomenon or cycle, and and it was actually only in females. Their studies. And I believe that's where the kind of you know perception that this is only happening in females occurs from but on the call today. I know that there are many, many males, and lots of you did answer, uh, to those impostor questions that you did have some doubts, so I think it's it's not, definitely, I know it's definitely not, uh, exclusive to females. This is a widespread issue for people of all demographics, but what happens is that you get more anxious. You get worried you might take it one of two ways you might over prepare, put lots of effort into it. Uh, or you might say, I'm going to put this off because I'm not, you know, feeling confident about it. Then you know you do well and you get positive feedback. But because you don't believe in yourself so much, you think it's down to luck or that it's just because the the hard work that you put in and it's not because of your skill set and you discount that positive feedback and then that feeds into your feeling of self doubt and uh, may even lead to a little bit of a depression anxiety. And so when the next time you get another task that increases the anxiety that you won't be able to achieve it, so why does it matter to you and the picture in the corner? There is an example of that It's not just you that had it. Einstein was one of the most famous people to, uh, probably you know, you, we would think, coined the most smartest person to, uh, having suffering with Impostor syndrome. It makes you miserable. It may stop you achieving your goals. And certainly when you're trying to present your best self, you may not come across as well as you could do. And so other people's perceptions may be skewed because of the impostor phenomenon. It reduces your willingness to, you know, pipe up. And, uh, you know, it's interesting being an educator and consultant and having the privilege of listening to you and seeing which people speak up and which people hold back. And I know that it's not the people that are holding back that, uh, it's not because they necessarily don't know the answer or that they, you know, they not intelligent. It's just because something is holding them back, you know, and and it's a shame because it might help the patient. It might help the department, but it may also reduce your opportunities to to work things out, and it may have an impact on your career if you're too shy. So why does it matter to us? E o e or so? Because we're going to lose the benefit of the your input If you are smart and have ideas, but are being held back by the anxiety of bringing it forward and we don't get an inclusive and representative uh, example if we, uh, don't hear all the voices because you're being held back by the impostor phenomenon. And then the field is left open to those more vocal people than who may, uh, not have who have, maybe overconfident. And that's the known as the Dunning Kruger effect, where their ability, their actual ability, doesn't reflect their perceived ability. So why do I have a bit of imposter syndrome delivering this talk? Well, because professor or doctor Valerie Young has got a whole website on it. And so I'm going to sign Post You two imposter syndrome dot com. Uh, and you can see lots and lots of facts and figures and a bit of ideas of how to deal with it yourself once again to reiterate you are not alone. And hopefully that group pole at the beginning has demonstrated that to you. But just In case you don't believe that your colleagues are truly feeling experiencing in Pa Syndrome, then you can see from these facts and figures from all sorts of successful entrepreneurs. CEO uh, women have had lots of lots of studies on them. Uh, it's rife famous people Tom Hanks, for example. You know, despite being a multi Oscar winning actor, he still thinks that he's going to be discovered. And, uh, everything is gonna be taken away from him and then on the right hand side of your screen, your you may not recognize that person, but you certainly recognize the company. He's the CEO of that company over many decades, but he's still Norman Schultz. You can't believe that he is the CEO and then finally down the bottom. Maybe she's unrecognizable because she changes so much. But Lady Gaga, you know, such a massive celebrity. But she still feels like the loser kid from high school. Uh, and but she puts it on so that she can be there for her supporters. And then some of you may or may not recognize this, uh, global celebrity, Liz. Oh, and, uh, she 2019, um, performed at the MTV awards, the Video Music Awards. And, uh, you can see the outfit that she was in. And she acknowledged after winning her prize that she does suffer with impostor syndrome as well. So lots and lots of people who have made it globally and yet feel that they are not the real deal. And this is quite an apt quote from, uh, so that it is privilege to the, uh, most marginalized groups not just in America, but probably in every aspect of life. So, for example, if you're a, uh, trainee and you've just come into the department, you may be experiencing that at the start of the job. If your medical student you may feel it. If you're any point of transition, you may feel it for the ethnic minorities or the any minorities. So female's ethnic minorities bme uh, etcetera, Whatever minorities you in the situation, you may feel it. Have we got any information about this in surgery? Yes, in 2019, uh, there were a couple of publications that the first started out. Uh, and you can see not too many patient too many responses, but it's 100 in that journal of neurosurgery and it showed in the neurosurgeons that your gender did matter. Uh, and that's probably because of that. The fact that the the gender, the they're a minority, uh, level of education was a factor. Um, but you can also see that the symptomology they didn't have it severely. Um, whereas you look in the general surgical education, this was general surgeons, and they found no difference between the genders, actually, um, but that they did find that the more advanced that you were in your training or as a consultant, that you had less symptoms of it. So it does maybe fade with time. This was the most recent study that was published, and it showed that, um, in general, surgeons, surgical trainees again, Um, it is Impostor syndrome is rife, and, uh, 76% of them have them. But once again, there wasn't any difference between the genders or the age of the responders. There's definitely if you like yourself, uh, then you are going to be more assertive. So I think, uh, in answer to Helen's talk earlier on, um, learn to like yourself. You learn to like yourself, and you'll be more assertive. So what do we do about Impostor syndrome? Well, you need to recognize it. You've already taken the quiz or a former quiz. But if you want to have a more formal, uh, in depth interview, then go to the Clancy Imposter phenomenon scale. Uh, and you can then have more detailed analysis of whether you are or not, uh, suffering from imposter syndrome. Also, recognize that the way you cope with it and your behaviors, uh, also, um, either a symptom of imposter syndrome or feeding into the imposter syndrome as well. So we mentioned earlier about hard work over preparing procrastinating. Some of us try and, you know, use a bit of charm and, uh, perceptiveness to to get away from it. Uh, others just hold back under the radar. And, you know, don't don't put our heads above the parapet. So why is it important to be positive? Because your, uh, words is there positive become your behavior. And if the behavior is positive, it becomes your habits and so on so forth, it becomes your values and your destiny. So that was told by, uh, one of the greatest people in the in the world, and and also from the same part of the world as your, uh, your training program director? No, not Northwest London, but Gujarat in India. Uh, and then another wise soul, George Lucas seems to have, uh, used, uh, Yoda as a, uh, Gandhi's word for Yoda. You can see fear is the part of the dark side. Fear leads anger. That seems to have been what Mahatma Gandhi was saying. Next bit of recognizing the imposter syndrome is what type of imposter syndrome you are, Believe it or not, you know, this is why I'm, you know, feeling imposter syndrome. Because I don't know the all the different types. Uh, but, you know, you can see. And if you go to the imposter syndrome dot com website, you can see the five different types that they believe that there there are you, maybe a mixture of any of these. There's certainly the perfectionist, you know, if you if you have one single floor and you then throw everything away and you don't care about the fact that you got 99 out of 100 right? There's the expert who wants to note and believes they should know everything. And if they don't know it. Then they feel, uh, the impostor, the soloist. I certainly work with someone who thinks that they should be able to do everything on their own without asking for help. Uh, if they can't do it, then there a failure. The natural genius. Once again, I work with someone whom I think is a natural. By the way I disclaimer I'm not a psychiatrist, and I shouldn't probably be making these judgments. But we all make judgments, don't we? But I I I'm pretty sure that there is a a few of my colleagues who, you know, they're so naturally gifted at carrying out certain procedures. And if they find that they can't masturah another one, uh, really easily then they just put it in the bin. And then finally, there's the superhuman who wants to be good at everything. And it's not just good, but excel at everything. Uh, out of all of these, I think that's probably me. I'd want to try and be good at everything, but no, that I'm shit at everything. Uh, this has been recorded. Sorry. Next step. How to deal with the imposter syndrome. So you've recognized it. Reframe it So look at this picture. Is it prints? William is he's giving you the flipping. You the bird. No, no, no. Look like an x ray. You need another view. He's just telling you, come to my house for a party at three o'clock. So you know, when you're getting that, um, positivity feedback do just see the positive sides of it. Don't dwell on the any negative words or any negativity about it. And then when you have done a gargantuan task, uh, don't be afraid to reward yourself afterwards. And those are giant profiteroles, by the way. They are the size of my my nose and those of you see my nose close up is a big nose. Uh, the and then orthopedics is not behind in trying to work out about impostor syndrome, this paper from a group of famous hand surgeons and somebody might recognize the name David Ring. He's now based in Austin, Texas, and, uh, the final author on their Prakash Jayakumar was actually at King's College Hospital, King's college, London University, uh, along with Mr a couple years below her, and he's now gone out to work out there. So you know, you can you can be anything you want if you if you put your effort into it. But it showed the study that basically the way to manage the imposter syndrome, which was rife amongst the the surgeons, uh, orthopedic surgeons, was to have a coaching opportunity or and sustained emergent surgeons mindset to improve their comfort joy at work. And then here's a local study that was done by our very own a partner, Viswanath, who is now a consultant orthopaedic surgeon, up in James Cook University Hospital Middlesborough with, um, a Rangan who's a very astute professor of orthopedic surgery and, uh, great shoulder surgeon. She's there, the the skill set, and she published this along with Helen Chase and Laura Young. And what I found interesting was that, um it was that, uh, highlighted. The trainees were asked whether an external comment had been made in the free text section and suggesting that more confidence was needed. 57% of the female trainees had such comments, compared with only 8% of male trainees. Yeah, you can see why there's this feeling of a gender, uh, discrimination. Let's call it that, uh is generally the gender is there a difference. Bear in mind, this is only a small scale study, though there was only seven females and 12 male trainees. So it's not quite big enough. But what it also showed was that maybe mentoring was what we require and hence leads back to our very own Helen Chase, uh, Rachel Fissure and Addie Abdelhak, who set up the e o E mentoring author mentoring program last year. But mentors and coaches can help you overcome your imposter phenomenon and not to, you know, forget the other side, because that would not be very diverse and inclusive. We were to forget the people who like to fly high, and, uh, so that's known as the Icarus phenomenon after the Greek tale about, uh, Icarus, who was the son of Daedalus who had and Dedalus was a craftsman. And he had been banished to the island, uh, to an island by King minnows and to escape the island. The the clever dedalus design some wings made out of feathers and wax and told his son not to go too close to the sun and not to go too low to the sea because of, uh, the possibility of, uh, problems happening. And, uh, as you can imagine, Icarus being the young, uh, belligerent son, he got more and more confident and got closer close to the sun. The sun melted the wax, the feathers therefore fell apart. The wings fell out, and he, uh, fell into the sea and died and drowned. Uh, that story is a myth, obviously. But, you know, I'm sure every culture has stories about the, uh, overconfident people. But that's the basis of the Icarus phenomenon. And you can see on the graph. That's what the Dunning Kruger effect is is also, um, pertaining to the fact that you actually abilities don't meet your, uh, perceived abilities. Whereas impostor dreams on the opposite end of that scale in summary, recognize reframe reward. And then so are you ready? Go figure it out as Liz. Oh, said, Anyway, if you need more help, then please go to these resources and you can become a sweat. Thanks. Now, that was great. Um, any questions from any trainees? Anyone that signed in? I think the really important point that Neil made there is around transitions and the fact that actually all be on an average day. You may not feel like you impostor around times of transition. So if you're going s h o to Reg register fellow fellow to consultant, I think just having that insight to know that you might have tendencies to impostor and how it might affect your practice, but also the people around you who are transitioning so be supportive of the new registrars coming in as S T three s or of new s a new CTS as they start from foundation training. Uh, just having that incites quite important. Um, Ahmed has asked a question. What is the difference between imposter syndrome and being humble? I don't think there is necessarily, uh, Imposter syndrome is the It's a spectrum, isn't it, as we've hopefully recognize there, and humidity is on one end of that spectrum. Um, it's when the humidity, if it leads to anxiety and fear of an avoidance of a task, I think that's when that's imposter syndrome. Yeah, I feel like it's a bit more invasive than just having being a humble or, you know, having that humility, isn't it? Any comments anyone would like to make about any of the talks today or any questions? Uh, I just answered called it to question whilst, uh, people come in with questions? Uh, yes, imposters, I I do believe imposter syndrome is good. I think you do need a little bit of it, uh, to, you know, stop you flying to to close to the to the sun. I feel that I don't have much anymore imposter syndrome. But the only time that if I look back on my career, I achieved the most when I was a bit anxious. And ms what are you talking about? You're achieving so much now know if you know you need to look at it in terms of objective measures. If, if you know, if one drop dead, um, what would be written about us in the obituary if indeed we made it a number of papers, number of procedures, number of innovations, uh, number of service improvements, you know, I don't know. We need to find that that sweet spot between a bit of imposter syndrome that gives us humility and productivity to the stuff that gives us anxiety. Um, and inhibition. Uh, see, that may be, uh, different people will have different perspectives on that, so not everyone will want to worry about the obituary? Will the I think it's an interesting point to make that, actually, perhaps over our careers. Although transition points are elements of imposter syndrome, actually, do we start to impostor towards the end of our careers as well? Do we then start to worry about whether or not we are still up to date? When is the time that we decide that we're wanting to start thinking about stepping down or reducing commitments coming off of a trauma rotor? Um and so I wonder if, actually, um, there is another point of imposter syndrome of Am I at that point that I've reached my pinnacle? Am I starting to come down the other side? How do you make that decision very wise? Well, I don't know. We'll try. Okay, guys, I have put the and girls I have put the feedback link in the chat. Please make sure that you fill it out. We're currently sitting at 26 responses on the resilience Teaching survey. If you are a trainee, that hasn't done a project yet this year, or there's a couple of you that would like to work together, let me know 26 responses can definitely be improved on if we can get, uh, the rest of you involved on What's that for? Who? For those that haven't been signed in today. Or if you're watching it on demand, feel free to, uh, fill it out. Um, and we'll see if we can do something with it. OK, great. Thank you to all the faculty. Fabulous. And thank you to all for being interactive, which makes it much easier to deliver these kind of topics. So, uh, for those of you that have registered see you on the 30th for the Complication Day. Otherwise, enjoy the rest of your weeks. Thanks, everyone.