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they, they hopefully the joining instructions to find near pod. If you go to join dot near pod dot com and pop in the code that's on the screen, you just need to put in a name when it asks you to. And it just allows you to join in with the the sort of the polls and the questions that are going to be put into you during the talk. Zack, I think appeared, um, he's on the NHS WiFi at work so he might be I/O. So if that happens, I'll carry on for him. Um, so welcome to this talk. It's about well being for medical students. Um, myself and Zach are both psychiatry. Trainees were based in, um, England in West Sussex On the coast. Um, I am an s t five and psychiatry. Zack is a called trainee. Um, just, uh, I've let them know about the one. Yes, I think it might. Okay, that's good. Thank you. Yeah, I felt something was going wrong. Um, have a backup just in case. Let's we'll see how we get on, but hi, everyone. Yes, exactly. So when we first started this presentation, Sophie and I were reflecting on on well being and and how often when we're asked the question of how we are doing, we often give a superficial answer. We have to sort of say, Oh, we're okay. But actually, if you ask the second time or dig a bit deeper, we often find that there are, you know, difficulties or challenges that we're all facing through and and certainly for yourselves. I'm sure you're You've been facing quite a number of challenges over the last year and a half to two. Several years now, Um and so this might be more personal to you than then. You know, then for other groups and what we wanted to start by doing which I hand over to short. So for shortly to understand what you're hoping to kind of get out of this session. Um, it'll be great just to hear kind of what you think you would feel the most valuable from this session. So, um, for those of you logged into near pod, I think only one of you is at the moment. But feel free to either type on the near pod program. If you have something in particular, you want to get out of this session or if you want to mute yourselves and just talk to us, that would be brilliant, too. We can also pop it in the chatting zoom as well. We're just really hoping to get an idea, you know? Is there anything in particular that when you saw the content of this lecture that you thought that would be really helpful for a particular reason or anything that is on your mind that you think would be helpful for us to cover, give you a few seconds to have a think about that soup? Yes. Just thing. While we're doing that Secretary, shall we try and add? Uh, add something to the chat box so we can so people can so access it whilst there If other people are joining in. Yes. Let me. He's a link. Sorry. I can't see who's joining in. So I'll pop in the link again. Um, for anyone that has joined late. Um, welcome. You're very, very welcome. Please, if you can join in on near pod, I've popped the link in the chat, and at any point, you can just go to join dot near pod dot com and pop in the code. The code is always at the top of our screen as well, and the light blue it just and that allows you to join in with the interactive parts of the session. Um, we're just thinking about what you know. There's anything in particularly hoping Scout of the session. So someone said maybe something to deal with uncertainty. That's a really interesting comment. And as I said before, both Zac and I work in psychiatry and there's a lot of uncertainty, particularly the patient, Um, in that kind of patient groups. So we're kind of from that respect used to dealing with it. But I suspect there's a lot going on outside of your medical degree as well. That's very uncertain at the moment. So we'll try and address that. Thank you for that answer. Okay, So the next thing we were hoping to know is, where are you based at the moment? Um, we know a little bit about the the charity and what these talks are for, but we realized we're not actually sure. You know, Um or at least we weren't until you popped in the chat for us. Are you in the UK at the moment, studying medicine. Are you over in the Ukraine? Were you in the Ukraine in the past? We've been displaced elsewhere. Or is something else going on for you at the moment? Uh huh. It looks like we got a bit of a spread, haven't we? Between some people being in the in the UK and some people kind of, uh, started formally studying in Ukraine, but displaced, um, we saw fit in line with what? We thought. We thought that there might be a number of you that are kind of either, uh, in Ukraine or, you know, currently sort of displaced the UK or also elsewhere. I think I saw somebody in the chat that said that they were currently in India. Um, so, actually, which is so something we haven't considered that, actually, people might be also displaced outside of Europe as well. Um, so, yeah, we hope some of this will sort of be quite relevant to them and some of the challenges that you're facing. Um, so some of this content that we're hoping to deliver you might find helpful. I think both sofa and I recognize that actually are going through quite a lot of challenges, not just within medicine within your studies, but also outside of it. At the moment. That will probably be having an impact on on your well being on your ability to manage certainty and and you know, the challenges that you would grapple with with medicine. Um, you know, for starters, the conflict that's going on in Ukraine is quite clearly having a major impact, and that is going to be really challenging as well as the issues around. If you have been displaced, if you have been forced to leave Ukraine or even leave your hometown, you might find that extremely challenging and find that have an impact on your study for those that remain in Ukraine. We know that there are a number of challenges that you'll be facing, you know, at least not only from the the risk of war that's going on there as well as you know the risk of, you know, losing your home and also access to healthcare as well. These things are going to be. The challenge is that you grapple with um, and one of the things that we thought was by helpful was that there is the this little table that we found from A from a research study that kind of looked at the impact of, uh, mental health in Ukrainian young people. And I suppose what we're looking to try and get out from here is that you'll be facing a number of challenges and there are a number of recommendations actually getting and put in place. But maybe not all of them have been put in place. And so you might be struggling. Understandably so, because actually, all the interventions need haven't been put in place yet. So we do recognize this is probably a really challenging time and equally very grateful that you're able to kind of come to this presentation and hear ourselves. Um, and we also wanted to acknowledge that there is some, you know, research being done into the mental health of asylum seekers and refugees across the world. And we, you know, before this talk, we did a little bit of a kind of a search on that, and there's not a huge amount out there. But what it did show is that anyone who is displaced from the country of origin experience the loss in some kind of form of both their social structures and support services, cultural values and also the community rituals that you're used to. Um and this is a quote from the Royal College of Psychiatrists. They have a working group for mental health enforced migration, basically, and this is the they're kind of mission statement taken from their mission statement. We know that mental health problems are more prevalent in people who have been subject to forced migration, both post traumatic stress disorder, depression and anxiety. Um, but also situate, um so disorders like psychosis as well can be more common to so, um, as well as all that. There's also all the practicalities dealing with all of the red tape finding accommodation, finances if you're still supporting a family whilst you're having to be displaced. And certainly, as is the case for for doctors coming over to the UK once you've jumped through all those hoops, you then actually got to find a placement as well in medicine, which has been quite a barrier in in recent years as well, and that we're trying to make a bit more accessible. But there's there's research all over. There was a particular study looking at Cuban migrants into the US A. And also people in the Lebanon Israel war as well back in the earlier two thousands. Um, so you know, me and Zack wanted to acknowledge that there are lots of these difficulties that might be going on for you that might be relevant while acknowledging the fact that we don't have a lived experience of what you're going through. So we were trying to kind of come come at this as a place of what? What is already known in the literature. But also, you know what? What we hope is going to be helpful for you. Um, also, it's not all doom and gloom. There is some research that suggests that actually having, you know, difficult experiences like this, for example, um, lots of things coming out of covid. 19 recently. But it can be a good educational experience specifically for medical students and doctors as well. Um, so you know, especially things like this charity that have, um, you know, set up these lectures. Hopefully there's not all doom and gloom, as I say, and we can try and find a way to make the most of the situation. So moving on, we're going into kind of the territory that Zak and I used to kind of talking through the UK medical students now as well. We know that there's a big burden from a medical degree in general and from specific placements, um, us both being psychiatrists. We will talk very briefly about those specific difficulties. Um, we're gonna try and help you understand a bit about burnout. An imposter syndrome, things that affect medical students worldwide as well as then some tools and strategies and some resources available ignored the reference to be S M s. That's our local medical school. I haven't updated that little graphic yet. Yeah, so we're going to focus. First of all, what? What burden is there in your medical degree to start with as a point to make out? I think, um, you know, one of things that we found in the in the research is that 65% of final years who were taking their final year placement and exams expressed, expressed being stressed, and the challenges that none of them unfortunately certainly help or any support. And whilst we accept that, we might not necessarily able to change the stress that you go through. What we're hoping is that more of you will be able to access the appropriate lovers of support or strategies and tools available to help help deal with these stressful times that you're going through. Mhm. So we know that within within medicine and that there is a you know, there is a number of things that can affect you within medicine and outside of medicine. We know that things around exams and, you know, difficulty and stress within medicine can be quite challenging. And also, the emotional experiences that you go through as well can be can be very challenging. Um, and then outside of medicine, we recognize there are other issues that can then start to impact, how you how you deal with medical issues and how you actually sort of progress through the medical years. So I've got another poll for you. Um, were wondering, so far, have you witnessed any consultations where there's been an angry patient, or perhaps the family or the care of a patient has been angry in the context of a consultation with a medical professional? A couple more seconds to answer. It's just yes or no. Have you ever seen a situation where a patient or the patient's family and carers have been angry with a healthcare professional? So at least one of you has, Um, for us, it's a really common situation. Um, so we thought it would be helpful to have a think about it as well. Yeah, so we often know that families and carers can be distressed and can be very upset. And there can be a number of reasons as to why that might be the case and the most common one that I've experienced both across psychiatry and also across my time working in general. Medicine is an expression of fear, and often a lot of families are afraid of whatever outcome that might be, which is what leads them to either be very upset or also to to be very angry as well. We recognize that often waiting times for us in the UK waiting times are a bit of a nightmare, and we know that people waiting whether that's either for an outpatient appointment or even in the ward round if it's taken a couple of hours and they're uncertain about their family member it can be a key trigger for people feeling worried and becoming visibly stressed. Previous healthcare experiences of those that have had negative healthcare experiences might look less favorably towards the service that you're providing. And that might be despite the fact that you're providing the best and appropriate level of care for somebody. So you might find that really challenging to to deal with or to understand, uh, recent bad news so similar around the expression of fifth, if you had to, uh, they've recently had a bad news, like a terminal diagnosis or life limiting accident or injury. Uh, that can have a major impact on their emotional sort of tolerance and the fact that they might therefore become more angry or upset. And then finally, the loss of independence as well. So whether that might be from a sudden accident, also or also from a more long term sort of chronic illness, uh, such as motor neurone disease or from a stroke, that lot of independence and not being able to do what you want could can also cause people to feel quite distressed and upset as well. So it's important to think that actually, if you have sort of experienced this, or if you have found something quite challenging, whether it's somebody feel that, you know, it's sort of being angry at you. How can you sort of process and manage that? And one of the first things to think about is to try and speech your supervisor and engage with them. Sometimes they might have information or have knowledge about the case that might allow you to one standard better. Or they might also say, Well, actually, maybe this is a case I need to take on and manage because of the complexities that arise from from those challenges. Uh, in the UK we have something called a balance group, which is essentially sort of like a support group, and it's kind of for doctors to be able to kind of discuss some of these challenging situations and and process it in a healthy way with your with your peers. So then you start to unpick a why you might have felt the way you did. Outside of that, you might have your own support groups where you may feel you can kind of discuss these, uh, these issues and actually process them as well and we often talk about healthy defense mechanism so kind of ways in which you can process a situation without necessarily always having to talk about it. So it might be, for example, whether that might be physical exercise. Or there might be doing a little bit of gaming, for example, these ways that you can actually process your your feelings quite healthy and allow that to sort of come out in a more healthy way, way offloading. Inventing is certainly a useful way to kind of discuss some of the problems and issues that you're having. The main thing that we always say is just be mindful of who it is that you're sort of offloading and inventing your difficulties to, um, so friends and family members will always want to be supportive and always want to try and help you. But it might not necessarily understand what exactly it is that you're you're trying to convey when you talk about these things. So just just bear that in mind, Um, and also, if you're doing on an online platform, just bear in mind to try and keep some anonymity as well, for yourself out for the situation you're venting. So then you're maintaining privacy as best you can. And as a final point, if you're find yourself progressively more irritated and more angry and finding it harder and hard to manage, these might be some of the symptoms of burnout, and we will talk about that sort of in some of the upcoming slides. So just something to bear in mind. The next poll is us wondering. Have you witnessed any other kind of difficult discussion between a healthcare professional and a patient? I'm just mindful that I think more people have joined ANZAC already put the link in the chat, which is really brilliant. So if anyone has joined late, we're using near pod to enable some interactive discussion. The code join or near pod is at the top of our screen in the blue, and you can you can take part in our polls and things. Everyone that's already logged into near pod. Have you ever witnessed any difficult discussion's between healthcare professional and the patient? I got a couple of yeses already. Just give you a couple more minutes. We've got a couple of yeses again. It's something that is incredibly common in medicine again, particularly common in our line of work and psychiatry. Um, in medicine. There's lots of difficult degenerative diseases, and having that discussion with patient's can be really, really tricky. Mindfield, um, for example, motor neuron disease, multiple sclerosis. They all have very poor prognosis. Um, diseases like Parkinson's and Alzheimer's can be really, really upsetting diagnoses to have to give to the patient and also the family, but also situations like CPR, cardiopulmonary resuscitation to counsel or work with patient's who are going through miscarriages or abortions. This isn't an exhaustive list that would be pages and pages long, but it's just to kind of draw out the fact that whatever specialty that you're currently working in or learning about, or whatever specialty you go into later, there's always going to be discussion's that are going to be quite tricky for every patient, but also some discussion's that you personally might find particularly difficult to go through with patient's For whatever reason, in psychiatry, we have the added difficult discussion's of topics like self harm and suicide as well, and at this point, we always kind of want to make clear that this again, it can be really common in the medical student population. But one in 10 medical students experience suicidal thoughts at some point during their training, which really is quite staggeringly high. And if it's something that you've struggled with at some point, it makes it very difficult at times to talk about patient talk to patient's about that topic as well. We also need to talk to our patient's about abuse and trauma that they've experienced and also things like substance misuse, which can be really difficult triggering or put people on the defensive as well. So again, what do we do? How do we process these difficult discussion's? How do we go home and not worry about it or still be replaying it in our minds afterwards? And it's sort of repeating a lot of the same things as we did for the slide on anger. It's about looking after yourself first and foremost, and we don't want this to be patronizing. We know that you probably know how to do this anyway. You know what things make you feel better when you've had a rubbish day, but sometimes we do need reminding, and doctors, especially we we spend so much of our life as medical students and then as doctors. You're giving constantly. You're always striving to do better to do the best you can do. And it's just the nature of, you know, you guys have been picked for your medical school. It's the nature of the people that want to do medicine. And it's really important to remind yourself to to have that break. Give yourself a break when you know that you're reaching the point where you've had enough, Really, The way in which you give your mind a break really depends on what what helps for you and what's good for you. And also, to some extent, what's what's a healthy coping mechanism as Sac talked about things like physical exercise are always a good shout if it's something you are able to do, Um, but anything pretty much that's going to be distracting, that's gonna be replenishing your kind of your ability to cope with these kind of situations. So again, we've suggested things like offloading to any kind of support group that you might have available to you any supervisors or colleagues that might have invited you to talk to them again. Friends and family use them with you know, a little bit of caution. It can be a bit much to to offload a lot of your medical degree and being a doctor on to people who aren't doctors who don't know what that's like. Also, if you have any kind of private counselors or therapists or anyone else that's in your life, that is there in that supporting role. So talked a little bit about the medical degree. Why it's stressful, the kinds of things that you need to bear in mind. We're going to have a think now about burnout, an imposter syndrome. So another poll for you Have you ever felt criticized by any kind of medical professional whilst you've been on placement in your medical school training are some quick answers there? Yes, is from two of you. Okay, I'll move on. My next question is, have you ever struggled with either the knowledge or the content of your medical school curriculum? So this might be the amount of stuff you have to learn. It might be the type of things that you're having to learn about, but at any point in your medical school training, have you struggled with any of that at all so far, it's got a yes. Already got to know. That's a good sign. Coping well, all right. Yeah, often. Sometimes it can feel quite overwhelming at the beginning. And then things start to click and you feel more comfortable. And other times, actually, it just feels like the burden College gets more and more. And so, you know, um, it often comes about in swings around about, uh I see a common there from, uh, that saying that, right? Mostly it's a large amount in less time. And you're absolutely right. Like trying to cram all the medical school medical, uh, curriculum into into five years. And realistically, it's only what, 100 and 50 weeks If it's 10 weeks of time, you've not got a lot of time to learn everything you're supposed um, so you're totally right with what you're saying? Yeah. So leading on from that, if you if you have ever felt criticized when you've been in your training or you've struggled with that workload, how did it kind of make you feel in your identity as a as a medical student, as someone at university, Um, how how did that make you feel not cut out for being a doctor. And you know what I was about to say? Let me share my own experience because that's exactly how I felt as a medical student. And it was in I did a four year medical course as a graduate, and in my third year we had our first lot of really important exams. And if we failed, it would have had to reset the year. And I scraped through and I'm talking by the skin of my teeth and that exact thought ran through my mind and repeats. You know, clearly, I'm not cut out for this and not kind of being a doctor. And someone else said unsatisfied myself. Yeah. And and again, you know, you guys have chosen medicine. You've been selected for medicine because you're good. You're a good student. You're good at what you do. You're very clever. You're very intelligent. You're driven. A lot of us are perfectionists. Um, so it's really tricky when you encounter these difficulties. You know, feeling left out. Not smart enough. Might have to be better. Yeah, I definitely resonates with me as well, and I think a lot of the things that you're kind of saying actually might be encapsulated in in some of the things that you might feel here when when you start to receive that criticism and that actually, you know when it's not in a constructive way or in a helpful way, it really belittles your own sense of achievement and you start to kind of doubt yourself and doubt your own skills and ability. Um, and you might. Some of you may resonate with some of these comments of thinking you're not perfect or that, you know, people realize that actually don't know anything or the other people are better. And it actually comes into comes under a concept or something we know as imposter syndrome. Um, now, what is Impostor syndrome it affects? For starters, it affects more people than you may believe. So we know that about 60% of people are are affected by imposter syndrome. Uh, 40% of people have experienced it weekly, and about one in 20 will sort of experience it on a on a daily basis. So it's a reasonable chunk of people in the UK that that definitely struggle with imposter syndrome and the the simplest definition to to define it. It's kind of the externalization of success, so kind of attributing your success to other reasons. So it might be luck. It might be that it must be a mistake. That was an error in the system. Um, whilst you then start to internalize your failures, you take every single mistake and say, Oh, it must be because I was the one that was at fault without actually looking at the wider context. You know, what were the challenges? Your face with the time you know, trying to cram in a lifetime of medicine in in five years is extremely challenging. So these these things start to build up, and it sort of comes to the concept of how do you define competency? What? What does that actually mean? And we often say that competent, you know, the traditional form of competence is how much knowledge do you have in your head? How much do you hold onto? And actually what we should be saying is, how well can you find the information that you need or locate the resource that you need to answer the question because, you know, medicine is as a as a way is evolving and changing dramatically. And to be holding all the information is not really feasible anymore. We have to look at other ways of how we measure our own sense of success. Now, um, we've we've got a little bit of a questionnaire for you just here. And I just want you to think about this for 30 seconds or so and just sort of say yes or no very briefly. If you started to feel any of these things, just picking it off in your head. Um, and I might be whether you feel more negative about medical school or difficulties attending lectures or even just feeling sort of less less thoughtful or less, you know, being able to be less supportive towards your friends, family or patient's. Yeah, yeah. So if if you have started to experience some of these things and it's kind of going on for for a long period of time and haven't necessarily noticed any any resolution or improvement, you might actually be starting to struggle with something that we know as as burnout. And that's something that Sophie will sort of talk to you a bit more about. Yeah, so when there's slightly busy picture. It's kind of encapsulating what we understand by burn out. So starting kind of at the left hand side of the picture. What is burnout? It's basically chronic psychosocial stress. What do we mean by that? Well, if you look at the scales on the bottom left, it's when the demands of your job are outweighing your resources to cope. If that's the case over a long period of time, then burnout becomes more likely. It can cause a crisis in a person's sense of professional competency. So this is going back to what Zach was talking about. It can affect the body, but also the brain. And a lot of the symptoms will mimic things like depression. So it could be a loss of motivation to do what you're doing. For example, your studies. It could be a growing emotional depletion. What we see quite commonly in psychiatry. We spend all our day empathizing with patient's listening to their stories. Um, over time, if you don't have the resources to cope with that, you just care less and less until you just don't care at all. And that's kind of the warning sign for burnout. you might become cynical or just feel depleted. Like what's even the point of doing medicine? I just don't know why I'm bothering. Could be fatigue. It could be just so like a bone deep tiredness, no matter how much you're sleeping. So for that reason, with that overlap, it often gets misdiagnosed as depression. Um, and it's not just stress that leads to burnout. It's stress when you have the inadequate support resources, and it's sometimes liken to a workplace safety issue. In fact, you know if you're doing a manual job, where you have to be up and down ladders if you're lifting heavy things, that by itself doesn't cause you to have an injury. But if you don't have the right tools to cope with those demands, that's when it can lead to an injury and burnouts the same thing long term. It means that it can destroy your ambition, your idealism, your sense of worth and in a you know, across the world when we need to be looking after our doctors and making sure that we can stay and do this job that we love over a long period of time, Then we need to be looking after them. We need to be making sure that burnout it's not happening. Um, so that's what it is. And you know, the worst case scenario, people will abandon their careers. They will feel like they can't be a doctor anymore that they're not cut out for it. You know, all of those negative thoughts creeping in convincing them that they can't cope. So bearing that in mind, what tools and strategies can we help equip you guys with to to cope with the things that we've been talking about? So, as I said before, I can't tell you how to distress because it depends on what you like to do. But I thought it be helpful if you guys could share the kind of things you like to do to distress. Um, sometimes seeing what other people do can be really helpful. Um, so I'll give you guys a few a few seconds to do that. Me and Zack are gonna add hours as well. And there's a few people who put down some of my, uh, my my my favorites, which include binge watching, um, kind of go wrong with a bit of a six series. Binge watch. I'll leave that up for a few minutes for you guys to keep adding if you want to. Um so, yeah, we've got a lot of watching things, um, thing. Yeah. Seeing friends and families. Brilliant. One. Spending time with people that replenish that kind of that love for what you do is really important. Um, and as we said before, physical exercise is also really good. So must put down cycling. It's my absolute nightmare to have to go out cycling, but that doesn't matter. It's about what is going to be useful for you. Um, you know, whether that's, um, I used to do body combat classes where you It's basically lots of punching and kicking, so that felt quite therapeutic. And I had a very difficult job at the time. Um, but eating That's definitely something I can I can try and get on board with, for sure. So, yeah, there's lots of different things that you can do, and it's. And as I keep saying, it's whatever is going to replenish that store of, you know, your own ability to cope with stuff. Um, we we sometimes, um, see some coping strategies Come up that, you know, if if not done in moderation might be unhealthy ways of coping as well. So, for example, um, you know, drinking alcohol, using substances, things that might be risky or dangerous. And, you know, going out for a drink is absolutely fine. I'm not saying don't do that, but to be aware of when the things you're doing to cope with, with burn out of the way you're feeling about the medical degree, if that's getting to the point where it's becoming more harmful than it is doing good and that's another point at which to seek help because we don't want things to go too far the other way as well. Okay, so the next thing we wanted to talk to you about is this concept of mindfulness, Um, and it's it's gained a lot of popularity, um, recently. And it's kind of, you know, for some people become a bit synonymous with, you know, being a bit hippie, a bit kind of spiritual, but actually we use mindfulness a lot with our patient's. Um, I do a lot of mindfulness myself, quite helpful. Um, and all it is really is the ability to focus your awareness on the present moment. Acknowledge and accept any thoughts of feelings and sensations that are going on, no matter how uncomfortable they might be, and accept them in the moment and work on just letting them go again. So why is it important? Why does it help? So it can be a technique to stop worrying. For example, I use mindfulness techniques just before exams because it's, um, it really helps to to focus on what you need to be doing instead of how anxious you're feeling. It helps recognize bodily so physical symptoms of stress, which we might be unaware of. I know that I carry a lot of stress in my shoulders. They just get really tense and hunched unless I'm focusing on it. I just I don't even realize until I've got a horrible back ache at the end of the day, and it just helps you avoid feeling overwhelmed with patient's that have kind of severe dissociated type experiences. But they don't feel like they're even really in their own body. Um, these techniques can help as well, so it's it is used all the way along the spectrum. How can you do it well, I'm going to take you through one technique, which is boxed breathing in a second. Another type is body scanning, so this is basically working from your toes up to the top of your head and just being aware of the sensations in your body. So that helps with those kind of physical stress or tension feelings. Guided imagery is another type. There's lots of different apps out there that Zach's going to go through a bit later. Lots of different websites that can guide this kind of mindfulness, um, that you might want to try out at some point. Guided imagery is just another way to focus something else apart from the worries that are going through your mind. Five cents Scavenger hunt is good for kind of panic attacks and acute anxiety. You have to focus first of all, finding five things. You can see four things you can hear three things you can touch or feel, UH, two things you can smell. And then you can either do describe the taste in your mouth or just take one deep breath. It's harder than it sounds to get through that, especially if you're really anxious at the time, and the thought is that by distracting yourself and just focusing on what's going on right here in that moment, and it takes you away from the panic of all what's going to happen in a month's time or whatever it might be. And I said, You can do mindful and then insect activity you like. If it's cycling that you like to do, as long as it's safe to do so, you can do mindful cycling. It doesn't have to just be sat there, um, you know, in a in a room by yourself, either. So we're going to do some box breathing. So what I'm going to ask you guys to do wherever you're sat, make sure it's somewhere that's relatively comfortable. And if you can make sure that both feet are flat on the floor, so don't rest 1 ft on the other, it just enables you to relax more easily. You can either just rest your hands in your lap or just by the sides of your chair, and you can either keep your eyes open and watch the graphic, or you can close them and just listen to my voice. In a sense, what we're going to do is just focus on the timing of our breathing. We're going to breathe in for four seconds, hold the breath in for four seconds, breathe out again over four seconds and then hold that breath out for four seconds. So the box part of the box breathing is that kind of equal four seconds of each stage of the breathing cycle. I'll try and time it with the graphics so it makes sense if you if you want to watch that as well. Um, And if you're feeling breathless, don't make yourself hold your breath and things just do whatever is comfortable for you. So if you let your breath out that you're holding, get ready to find my instructions. Breathe in and hold without and hold, Breathe in and hold, Breathe out, hold, breathe in hold. Breathe out. You can breathe normally. So I just took you through a few cycles then, just to get a feeling for what it's like, Um, if you're not used to doing it or if you're already feeling anxious, you might have to reduce the time that you do each stage for or not do it for quite as long it can make you a little bit lightheaded. Um, but as I mentioned before, I really love this one for right before exams, especially the practical exams. We call them off skis in the UK Just when you're about to go in that room and you're reading through the little blood and it's making you really anxious, no one can tell you're doing it. And the great thing is that by forcing your breathing to calm down, it will feedback to the autonomic nervous system, and it will reduce the amount of adrenaline going around your body. Your heart rate will also come down along with it. All of the things like the shaking and the sweating, will also be down regulated, too. So if you're someone that gets a lot of the physical symptoms of anxiety, the box breathing is really helpful. I have to say always fine, doing the box breathing quite helpful before I get into my next bit because it always helps me a little bit more calmer as I as I talk about some of the apps and some of the things that are available, um, so the analogy that I always like to use with this is that it's always important to put your own mask on before helping others and as well as some of the mindfulness and some of the other ways you might distress. So then you can help others. We can also use apps as a means to help kind of give us that on the go use and tips and tricks and techniques that allow us to do the stress, chill or find some of those, um, ways of learning. Uh, do mind for this. And so there are a number of both paid and free apps that you can access. There's there's sort of a mixture that are on here, Um, and the first one that I've got up here is something called WhatsApp, which is not to be confused. WhatsApp, as you can see, as I found on Google store quite a few times, it doesn't confuse it, but what's up itself is actually really interesting. It it uses a couple of concepts from from psychology and psychotherapy, um, specifically cognitive behavioral therapy and some of the good acceptance and commitment therapy. So just kind of being able to reconcile with some of the emotions and challenges and understanding how to balance those things. Um, it's designed to help with depression, anxiety, anger and stress and helps to some of those. If you're getting into those negative thought patterns that are quite psychical, quite hard to shake off, it can help with those things as well as diary, providing direct and monitoring thoughts and even like little games to help ground yourself. Head Space is one of the apps that provide a trial for two weeks, so this is a quite a well known app that helps to provide spaces for meditation, mindfulness, as well as helping you with sleep as well. And it sort of helps encourage and support habits that improve your mental health. As I mentioned before, you can get two week trial to begin with, and unfortunately it has a cost of 50 lbs per year. So there is a price tag attached to it. Calm again is another app that has a free trial, Um, and it's designed predominantly to help with sleep as well as meditation and relaxation. Um, a 37 day a trial for the full features, after which some of the content is locked. Afterwards, you can access some of it, but not the entirety of it. Um, and it now comes with a cost about 28 30 lbs a year. Or, if you have the money for it, you can make a lifetime purchase for 300 lbs, which I think all of us have lying around. The final one, which is which is a free app, is one called mind shift. And this is an app that's designed to help around anxiety and similar to WhatsApp. It uses some concepts from some psychotherapy. So something specifically called, uh, Congress of behavioral therapy again. And it incorporates a lot of different tools that you can use. So things like journals to kind of derives your thoughts and see where they're following at the moment, things like coping cards, you can use positive motivation and and affirmations, um, looking at experiment for your beliefs. So if you're starting to find you have recurrent beliefs that quite difficult and you're holding onto you can use these kind of test them until you actually is is definitely true. Am I sort of, uh, you know, are these negative thoughts are holding on to me, and it also has a community forum as well that you can engage with other people. So if you are finding stresses and challenges the anxiety, you can use this as a way to kind of actually engage with other people and find out maybe you might not be as alone in your thoughts as you may feel you are. So I think that kind of brings us to, uh, to a closure into an end of the talks that we've, uh, that the talk that we've been given. We've spoken a little bit about recognizing the burden from the medical degree placement as well as the challenges that you face both in and outside of Ukraine, whether you're there or being displaced. We've spoken a bit about some of the challenges that you may experience within medicine as well as burnout and imposter syndrome, and we've also looked at some of the tools and strategies that you may use. We've got looked at. The resource available would be a semester, but we appreciate there are some available that you might find helpful. Um, and what? Some of the conclusions that we wanna hand turn to you. We recognize that medicine can be daunting that is totally understandable. You know, I know Sophie has spoken about it a lot, and I speak about it as well. That medicine was a really difficult time, like I enjoyed it and it was fantastic. But there's some real challenges in that as well. And you may also be facing an additional burden, an extra burden from everything you're going through within Ukraine and and your displacement potential displacement as well. So if you have the support, connections and things available, it's really important to try and access them. Take a bit of time to think about how you cope and think about how other people might be coping as well and just find, you know, your avenues in ways of support. Uh, we did a little bit of research when we were trying to do this just to try and help, maybe understand what might be accessible to you. And there's a number of resources you might find helpful to be dealing with kind of displacement or while you're in Ukraine. So just a couple of things here is whether some of the resources and um yeah, we just put our emails on the bottom as well So if you know if you've got any questions or queries or you know anything you want to flag up to us, then feel free to do so. But we're also kind of happy just to answer any sort of general questions or queries you might have, you know, kind of related to well being or just things that have come up in the presentation. Okay, we've got a little survey as well. I know there's one that's kind of going out on the Crisis Rescue Foundation is doing one as well. We've got our own one as well that hopefully shouldn't take too long. But particularly as you are, our first group that we've delivered this session too, would be fantastic if we could just get some points on how you think this has landed. And if there's anything that we could do differently to kind of, uh, kind of scope this right, and better for you. We do provide this in the future, but yeah, thank you so much for your time and and we really appreciate it. If you have anything you wanna ask them, feel free to do so. Thanks for listening and taking part. Everybody and I just like to echo what Zach said If you do have a moment to give us a little bit of feedback so that we can make this session as helpful as possible, um, that would be absolutely brilliant. And if you do have any questions, then you can either contact us on our email addresses or, well, hang about until four. If you wanted to ask us in the chat or remove themselves. Thank you guys. That was excellent. Um, and, uh, we can share some of those resources and take home message is maybe you've got, like, a well being checklist that we could send around to all the students. That would be brilliant. Uh, not trying to give you more work at this late stage of the year, but, you know, seeing as you sound like an energetic pair, why not? The worst that can happen is you say no. Uh, so, yes, I got really good, uh, feedback and just waiting for as many people as possible to click on the link. So we get we get all our feedback to help keep our med school going. Um, yeah. So thank you. Thank you. Very very much. Thank you for putting this together. We really appreciate it. Very welcome. Hopefully, it was helpful. Yeah, it's been an absolute pleasure. So we really appreciate having the time and opportunity to talk about it. Um, whilst I saw people around, I thought one thing that was interesting was was something flagged up at the beginning, which is kind of the point about uncertainty. And just as we're delivering the presentation, I was kind of thinking about that and sort of the journey one can have with uncertainty. So this might be a bit of a monologue, and I apologize in advance, but I think you know when When you start off as medical chin, you expect to kind of know everything, and you feel that when you don't know something that becomes really unsettling and really, you know, sort of like, Oh, my God, I don't know this this is really challenging. Um, and again, it sort of feels that sense of inadequacy. And and I think one of the skills that you learn over time is becoming more and more comfortable with uncertainty. And, you know, as I've sort of gone on to sort of you know between being a foundation doctor in the UK and going, uh, especially training. Um, there are times where I've had less and less time to interview people and get the full history and information. And actually, I don't need to collect everything. I don't need to know everything. I just need to know enough to give me a bit of an idea of what's going on and to kind of formulate the answer that I need to actually help me. Um, you know, figure out what's going on with this person in front of me that's struggling and how I can help them. So I think you know, if you are feeling uncertain as a medical chin, I definitely felt I definitely felt Why don't I know everything? Why, Helen, I got the answers. And actually, over time, you you know, you You you collect enough experience, you start to think Well, actually, I don't need to know all this information. I don't need that specific a bit, but I do need to know X, y and Z, and that might help you feel a bit more comfortable as time goes on. And I totally agree with what you just said Zack. The other thing that I find really helpful to remember is that in uncertainty in general, you can only control the things you can control. Many things are going to be outside your locus of control. Um, and to some extent there's, you know, only so much use in worrying about those things. Um, if you can focus on the things you can control, for example, you know, if you're you know, in the in the example of sat with a patient not knowing what's going on with them, you can control what questions you ask. You can't control how the patient's going to react to those questions you can't control whether or not they're going to take their medication you can't control. You know, the social stresses that are going on in their life. Um, and you know, there's there's a lot of that in medicine. There's a lot of that in just day to day life, and we can't possibly worry about all those things that we can't control and that we are going to be uncertain about, Um, But if you're finding that that uncertainty is intolerable and you're really struggling to cope with that. Then again, that might be a sign that you need a bit of help at the moment and that this is your sign to reach out for a bit of extra support if you need it. Just as strong job. Not a problem at all. It was was a great question. You a great point that you raised at the beginning. So I think it was kind of worth worth answering and putting that forward. So I appreciate you putting that ahead. Okay. Shall I stop the recording now? Yeah. So I didn't catch the last bit, so I'm not sure if I might have missed something. Uh, that sounded all right with me. Yeah. Okay. Thank you so so much again. I'm going to stop the recording now.