Leadership Fellowships (24 Jul 2024)

SPEAKER_00 0:13

Hello everyone and welcome to another episode of Career Conversations brought to you by the Royal College of Physicians of Edinburgh Training and Members Committee. My name is Marilena Giuniudi and I am on the Training and Members Committee. And today I'm delighted to be joined by Kirsty Crow, who is also on our committee this year. Kirsty, welcome. Thanks very much. As you know, and as I hope some of our listeners know, this podcast is about laying out the jobs and what opportunities are out there. And I know that leadership fellows are becoming increasingly popular as jobs. So do you mind starting with why you decided to undertake that? Yeah, sure.

SPEAKER_01 0:57

It's a fellowship I hadn't actually heard all that much about until a couple of my friends had gone through it, and some of the experience they described were really quite unique and things that I hadn't encountered before in training. I was quite keen to broaden my horizons beyond training and feeling a little bit kind of stuck in the hamster wheel. The particular fellowship that I applied for was just a year out of programme and it was very flexible with location and things like that. The more I looked into it, the more it appealed to me. Really, there was a few things I was quite interested in. Like the first being just having a wider understanding of the system and how it works and how I can potentially influence that system for the better. We've all been there when we want to make changes in our working environment or feeling a little bit helpless, feeling like overwhelmed with the bad bits about the job and not really knowing how you go about changing that and who you go speaking to about it. Those are the things that appeal to me and also just meeting new people as well.

SPEAKER_00 1:51

What kind of things does it tend to include? Is there any clinical work at all? I assume that there'll be some flexibility depending on why you do it, you know, your local deanery and so on. But what does it actually involve?

SPEAKER_01 2:05

Different fellowships will involve different amounts of clinical work and non-clinical work. The exact structure of the fellowship will be really different depending where in the country you do it. And all countries in the UK offer fellowship schemes, some offer more than others. The one I did was based in Scotland and there was no clinical obligation, you didn't have to do any clinical work. Some of us did ad hoc locum shifts to keep our clinical skills up, some of the cohort didn't do any, it was personal preference. How it usually works with most of the fellowships is that you are based with one or two host organisations, so organizations that are connected with healthcare in some way. You're based with them primarily in terms of doing project work, in terms of doing some experiential learning, getting involved with speaking to people that work in that organisation, shadowing some of the executive teams, for example, getting to join various working groups and things like that to progress change. You've got your host organization part of it where you're putting the theory you're learning into practice there. And then the other strand of it is usually you're working with a cohort of your peers and getting some bespoke leadership and management training and learning, and that takes the form of workshops, of peer reflective work where you come together as a group and reflect on things that are going well, things that could be better. My fellowship also gave us the opportunity to have some career coaching as well, which was a very different experience, something I'd never experienced before, where I had one individual just talking to me about my career and coaching me through certain things that I found challenging. And it was quite intense, but it was a really, really good experience. And it's actually quite interesting when you speak to some senior leaders in healthcare, how a lot of them do actually have a coach and they find it really useful. That's something I'd never heard of really as a concept before in healthcare. The structure is quite variable depending on which organization you might be working for. And some people, their fellowship is actually a part-time fellowship where they stay in their training post but maybe go down to a certain less than full-time banding and spend a couple of days in a leadership role. Some people might have also heard of the term chief residence or chief registrars, and that can be a more localized leadership opportunity where you don't come out of training at all, but you take on a new role that bridges you between the trainee voice and the organizational and executive management of the trust or board that you happen to be working with, and you can get involved with various activities that way as well.

SPEAKER_00 4:24

And I'm glad you touched on that because I'll just do a small plug for a conversations episode that we do have, which is on the chief registrar job. It was slightly different of the episode that we describe it in, in that it was for a post that you actually apply for and you come out of program for. And I think that's where we potentially have to highlight the differences between doing these posts in different deaneries in different parts of the country, because I do think that there probably is a bit of a crossover between leadership, fellow post and the chief registrar role. And it's just about doing the research for yourself when you do go into this to see what suits you and the opportunities that are available to you for the job that you apply for. I'll start plugging there and I'll ask you, obviously, mentioned all the different things that you've got to do during that year. What was a typical day like for you? Was it just attending meetings? Did you do anything else more hands-on? Did you have a project that you started? Try to see through, or what was the actual nitty-gritty like?

SPEAKER_01 5:24

I'm not exaggerating when I say no day was the same. And whenever I had people who were thinking of applying for the fellowship coming to me and asking what does a day in the life look like of a leadership fellow, I honestly couldn't tell them. I had to basically give a synopsis of my week to give it an overall summary. It was a mixture for me of online work and work in person. That's one of the advantages of a lot of our virtual working now, is you can be really flexible. And the nature of the Scottish Fellowship was that you could be placed with an organisation anywhere in Scotland, no matter where you worked. Both of the organisations we're hosted by were actually based in Edinburgh, though I live in Glasgow. The first organisation was an NHS Lothian's Medical Education Directory, and that's a board in Scotland that covers the Edinburgh area. And the second organisation was the General Medical Council, the Scotland team of the GMC. And obviously the GMC is an organisation that works across the whole of the UK. So I did a mixture of work with the GMC that applied locally and some that applied nationally, and I got to meet other leadership fellows across the UK as well. I did a combination of joining meetings and giving my clinical opinion or my trainee voice, depending on what was relevant for that particular host. I chaired some working groups, so I gained skills in chairing, and that was to push forward high-level quality improvement work or push forward certain projects. And I had loads of projects that I did. They ranged from supporting international medical graduates in the workplace in Edinburgh and also feeding that work back into the GMC to improve its processes. I did a lot of work on trainee well-being, not let's do lunchtime yoga and give everyone a free pen, but proper work that actually helped systemic causes of burnout and poor well-being in our trainee workforce and working to how can we influence those factors. And so sometimes that involved being part of a room with lots of different representatives of cross-healthcare in Scotland, everyone from the colleges to National Education Scotland and to representatives of Scottish Government, and really putting it down on the line what trainees need and what they don't. So it was a lot of work like that. Other things I might do during the week were attending conferences that I found interesting. So, for example, I've got an interest in climate health, and so I had an opportunity to attend a few conferences related to that and work on some project work with other leadership fellows and working out how we can push the net zero targets in Scotland further. Other things that I did would be attending the career coaching, or we had a book club between us all, forced us to read some leadership books, which I would have never in a million years read on my own. It's a lot more fun when you read them and then you get to dissect them with your colleagues and work out what works for you and what doesn't. And the theory side of things, doing workshops, really reflecting on yourself and how you interact with others and how you can behave with others and how you can make them feel was all really intense but really important learning as well. And that was a mixture of online workshops and face-to-face. So it was really, really varied. And some of my work was in hospitals, speaking to other trainees or meeting board members, or teaching medical students about aspects of leadership and management. And there was lots of other opportunities to get involved with other things. We were offered a chance to get uh formal qualifications from the University of Glasgow, the GMC. I was able to travel down to the London and over to the Northern Ireland office and to meet the team there and do some collaborative work between them. It was really varied, and I honestly can't say any day was the same. Yeah. It was a lot more meetings than I'm used to in my clinical work. I did struggle with that at first. And it's amazing how much you have to learn about meeting and teams etiquette that you maybe didn't know before, because we're just not as used to doing that necessarily in clinical work. So it was quite interesting watching how other people manage a meeting, manage a room and get constructive dialogue through it rather than just a never-ending meeting where there's not a real chair and people, you know, don't adhere to proper meeting etiquette, so then nothing gets decided and nothing gets done. And it's interesting coming back into clinical work how you can get so easily frustrated coming out of that environment where it ran so smoothly to feeling like you just want to grasp control of the meeting and make it more effective. And it it's interesting you don't necessarily realize how much you've learned until you reflect when you're back into your clinical environment.

SPEAKER_00 9:29

So that was a very long-winded answer. I mean, that's good because it shows all the different things that you can get involved in. If it's okay with you, there's just a couple of things that I'd like us to go in in a little bit more detail. One of them was the formal qualification that you said. Is that part of all leadership fellow posts? And if so, is that something that's funded for you? Or did you need to fund it yourself?

SPEAKER_01 9:54

So different leadership fellow posts will have different opportunities. So, for example, I know the H E I W post in Wales, the fellows there do a PG cert in leadership, which is funded by that scheme. Our scheme in Scotland didn't have a formal diploma or anything at the end of it, but we had access to National Education for Scotland who'd linked with the University of Glasgow for these micro-credentials. The Fellowship in Scotland didn't have a specific formal qualification associated with it, but the team signposted us to a huge range of opportunities that you could get involved with wider leadership qualifications and roles out with it. So, for example, if you'd wanted to, you could have trained and applied to be a coach and gain a coaching qualification so you could coach others. They had access to the University of Glasgow micro-credentials, which are available for a select number of people across healthcare in Scotland, and it was free of charge. And that wasn't funded by our scheme per se, but it was funded by National Education Scotland and it didn't just apply to medical staff. So I did that and I got to meet quite a few different people from all aspects of healthcare doing that. It's quite variable if you'll get a formal qualification or not. I think what's probably more valuable than a piece of paper saying I've done this, it's about the experiences that you've learned and the fact that a lot of the work that you do in these fellowships is so relevant to your consultant work. We don't realise what a consultant does if they're not on the ward or if they're not on the shop floor, if they're not in clinic, or how does a GP manage their practice? A lot of this stuff we don't really get that much exposure to in training unless we actively look for it. Obviously, different training programmes will offer different opportunities and in different areas, but it's realizing that a large amount of your role will not actually necessarily be clinically facing, so patient-facing, and you'll suddenly be expected to lead and manage a team, be able to write business cases, be able to put forward your agenda and influence people appropriately in the setting that you're working in. Whereas if you just go and demand things and post on Twitter while you want it, it doesn't tend to happen that way. I think that is the most useful aspect of it is actually getting an insight into what happened behind the scenes and what skills you might already have and what you need to develop further. And then giving you structured year that you can pinpoint what skills you need to develop, much like any other skill, you know, you realise, oh, I'm not very good at lumbar punctures, so I need to practice that. It's exactly the same with the leadership and management skills. You're not born a leader, you don't just come out in a superhero outfit. There's different ways of leading and managing a team. With we can all think of people that we felt well managed by and people that we haven't, and different styles will call for different situations. So having a safe year to practice those skills and to realise things you're maybe a bit rubbish on at and things that you need to improve is really, really valuable and less of a steep learning curve, I think, than when you take on a senior medical post.

SPEAKER_00 12:48

I'll come back to skills in just a little bit. The other question that I just had from what we've spoken about so far is career coaching. I know that it's not mentorship, it's something completely different. But could you maybe briefly describe to us what career coaching actually is and maybe what you gained from it?

SPEAKER_01 13:09

Career coaching is essentially when you come to a completely confidential session with one person, it's a kind of one-on-one, and you bring a specific issue or specific problem that you're wanting to dissect and reflect really deeply on, and that skilled facilitator will take you through that reflective process and reflect a lot of your thoughts back to you. And different coaches will have slightly different styles, some are more directive than others, some will get you to do all the work and you're coming out with all the answers that you already have, and some are a little bit more direct to like suggesting different techniques to try and bring it back to the next session. And they're not necessarily somebody that does the same job as you or works in the same area as you, but they have professional qualifications and they've done various courses and observed and rehearsed practice that they know how to bring out really deep thoughts and deep subconscious things that you've maybe not even thought about. There's actually quite a few parallels to how we take a medical history there in terms of quite often we're getting the patient to answer something that the patient maybe doesn't even realise is something they're experiencing, and you're doing a lot of open questions and reflecting back on what somebody's saying to you in order to get them to progress what they're thinking. And so there's quite strong parallels between coaching and taking a history. The difference is that we often are trying to get to the right answer and present the answer back to the patient and give them a plan. It might be a shared plan, whereas coaching, they're tending to reflect back on you for you to bring the answer to the table because it's your life, it's your direction of travel rather than theirs. It's useful if you're coming up a crossroads in your career, so you're maybe not knowing which way to turn in terms of going for switching specialty, for example. People in my cohort reflected really hard if they were in the right specialty they were training in during this year, because it was a year to decompress and to really think about what their skill set was and what their priorities were. Other things you could take to career coaching were more current things, like things you were struggling with in that month. Some things I brought were often how do I build on some skills, like just when I was chairing meetings, I wasn't necessarily very good at delegating all the work to people, and I ended up taking on so much of it myself when it was like a group task. I felt like I was carrying the group quite often. That's something I probably could put back to be a bit of a people pleaser. Exploring that in a career coaching session was really helpful in terms of understanding where that behaviour comes from and how to go about modifying it. So I see it as a mixture of deep reflective conversations, a bit of counselling sometimes, like a lot of us cry during our sessions, just really helpful structured advice and a little bit of reframing of how you think about things or thinking about things in a less negative light or thinking about things in a different frame that you hadn't really thought of before, and it might help you find a solution that you had all along but you didn't realise it was there. Mentorship tends a guiding person, so somebody that's more senior than you that has gone through very similar experiences and can give their wisdom to you, so it tends to be a more senior version of yourself, i.e. someone in your specialty or um related specialty or somebody in a role that you quite aspire to be in in the future. So whether that be a leadership and management role in the organization or an educational role or a research position, and that person can give their wisdom and show a bit of a guiding path into what they struggled with and what they found beneficial. That's the kind of difference between the two, really. But the concepts are often quite overlapped and quite blurry. Hopefully that makes sense to people listening.

SPEAKER_00 16:39

I think it does, and that's a really good way of describing it and clarifying it. If we move then back to the leadership fellow, what do you think were the three most important skills that you learnt during that year?

SPEAKER_01 16:53

Well, that's a really difficult question. But I say the most important one, and this is going to sound incredibly cheesy, but it's true, and I can't get around it, was understanding and respecting myself and who I am. And by that I mean letting go of things that and maybe being quite harsh about myself and learning to relax and actually look after myself. It's incredible how much you realise that you give yourself to the job and to the career maybe don't properly make time for you. And if you don't have that headspace yourself and you don't know how to switch off from work and relax properly, then you're going to really struggle. That is one of the things that can really lead people to burning out. And I'm sure a few people listening might recognise some of that. It was not only a year out of training, but it was a year focused on really deep self-reflection and working out, well, what drives the way I think, and why do I react that way in a certain situation, and that really helped me understand who I was a bit more. That would be the top one, and it's definitely quite cheesy, but there's no way of me really describing that without saying it. The second one was the ability to chair, so the ability to get a meeting together, make sure the right people were in the room, and have a structured agenda, work out what the pushes and pull factors of that meeting are, and what you're wanting to get out of that meeting, make sure it runs to time, but also the discussion is really constructive and that there's clear communication afterwards about what everyone's role is in that meeting. That's a skill that I got to practice a lot during the year, and I'm a lot more comfortable with it. And it's useful for things, even like if you're chairing a conference and you're having to keep people to time and you're having to think you have questions to ask people after they delivered their abstracts or things like that. It's a skill that you realise actually does need a bit of practice, and the more you do it, the easier it gets. I was in quite a fortunate position I could watch some very senior people do that and work out how they could get the room to reach a consensus or how they could balance some really difficult personalities in a room and still have a constructive meeting rather than it all kind of falling apart because you've got two people at loggerheads, watching that people manage that was really fascinating. That was the second skill that I learned. The third one, I'm not sure I would say it was a skill, but I became a lot more curious and my eyes were opened to what I can actually influence and change in my training. And the answer is a lot more than I thought I could, and understanding what influences a system and why it happens. And I think if you understand why your organisation might work in a certain way, why the GMC survey comes out at a certain time, why communication comes from your training program director, you can understand a lot more how you can change something for the better. And I think combined with knowing myself a little bit better, have a bit more headspace now to have ideas of how things could change, be a bit more curious and be a bit more interested in actually not just moaning and hand-wringing and thinking, oh, why wouldn't they just change this? Or why are things so unfair and just moaning to my friends and creating a bit of an echo chamber about it? It's like, well, what have I actually done about it? What have I actually done to change it? Who have I spoken to? How can I help change it? Not just demanding someone else fixes it, but how can I be part of that change and how can I help them change it? Because quite often a lot of the senior people that we label as managers that don't care about us, they do, they just don't necessarily go about things in the right way because they're just not seeing things from our perspective. So I'm finding how you can use a trainee voice quite effectively rather than just raging into the void would be the third thing that I think I most valued from it.

SPEAKER_00 20:19

Can I ask what stage of training did you take in order to do your fellowship post?

SPEAKER_01 20:24

So I was in the middle of my higher specialty training. The particular fellowship I did in Scotland that what's who it's advertised to is more senior trainees. But I do know that other fellowships across the country, you know, people have done it from post-FY2. There's medical students that do fellowships these days. I feel like medical students are a lot more on it with things like newships and management than I ever was. I mean, obviously I'm saying this because I've I've done it, but I I found it most beneficial as a senior trainee, just because by then I'd been in the system long enough and I could see the end point of being a consultant and working out how am I going to transition to get to that senior place. So you could take different points out at different points of your training. So either an outer programme during a training programme, or if you're going between one part of your training to another, so say from foundation to core surgical training or whatever, that natural pause where a lot of people take a pause anyway, might go travelling or they might do a clinical fellowship. Maybe they would choose to do some teaching fellowship type work. Leadership fellowship is another possibility. Researching them, thinking, what would I get out of this? Why do I want to do it would probably influence when you would decide to take it. If I'd done it earlier, I'm not sure I'd have got the same benefit out of it as I did doing it as a more senior trainee.

SPEAKER_00 21:39

Excellent. I'll put some links on the footnotes of this podcast for different opportunities. And then whoever's listening to us, if they do want to read more about it and see when it would be the right time for them, then they can do that in their own time. My last question is do you think you need any particular skills going into it? Or you're going to learn everything that you need when you're in it and Anyway. The only thing you need is to go in with an open mind.

SPEAKER_01 22:05

That's all you need to go in with. You certainly will not come out of a fellowship suddenly being the next CEO or medical director in making in that year will not teach you all you need to know about it. It's almost like a start of thinking in the right direction and how you can continue that learning going forward when you come back into practice. I would say that about probably any programme experience. You don't become a top researcher with your PhD, that's the beginning of your research career, or you don't become a an expert educationalist in a teaching fellow year. So in my opinion, you don't need any particular thing. And as I said earlier, there's lots of different ways of being a leader and different ways of managing a team. You just need to be open-minded. And by that I mean listen to what people tell you. Take it on board and not be closed off to how you can reflect on how you are and how you can maybe try out different things and grasp lots of different opportunities and not go into something really cynical and think that everyone's out to get you or the system's corrupt and terrible and it can't possibly change. And just remember that a system is just people. You can influence people and you can get people to change their behaviour. That's what I would say is the only thing you need.

SPEAKER_00 23:13

What piece of advice would you give to anybody listening to us that would be interested in applying for a post like this?

SPEAKER_01 23:21

I would say if you can, try and find somebody that has done one before so you can ask the specific questions that you want to ask. Because as I did a very bad job of highlighting earlier, it's quite difficult sometimes to kind of describe what you did because you did so many things, but it's easier in a one-to-one conversation over a coffee or whatever. There's also quite a lot of free resources that each of the educational boards across the UK host, and we'll put links to those at the end of the podcast as well, which means you can explore different aspects of leadership and management so to understand what kind of components you might do a deeper dive into during that year, seeing if it is something that would interest you. That would be what I would say if you were interested in doing it. Definitely speak to someone that's done it before and maybe have a bit of a read-round about what does leadership amager actually mean and what kind of skills can I expect to develop during that year.

SPEAKER_00 24:15

And my very final question, and it fits in perfectly with you saying having a read, is you mentioned before that you had a book club and you read lots of different books that you wouldn't have otherwise read. If I can put you on the spot and ask you, which of the books do you remember that really stood out to you, or which book would you perhaps recommend? For anyone listening, this isn't a plug for any books as you can tell, because Kirsty was not expecting this question.

SPEAKER_01 24:43

I would say probably the one that stood out the most was a book that we read that was by Brittany Brown, who is an American researcher who basically has made her career studying leadership and particularly looking at how vulnerability and shame relate to that. The book that we read was called Dare to Lead. There were some really good ways of thinking about things that I hadn't really thought of before. And like all of these books, some people read these things and think, oh, that was amazing, that's changed my life and rave about it. But I think most of us read these things and we take some things that we thought were good and some things we think, no, I don't think so. But it's amazing how many times since I've read that book, some of the theories and concepts she described have come up time and time again. It's surprised me a little bit, shows me how much I absorbed from the book that I maybe didn't quite appreciate when I first read it. Really divided our book club cohort. Some people absolutely hated it and some people loved it. No matter if you hated it or loved it, they got you talking about it and it was frequently referenced thereafter at a lot of our training days. So I would say that's quite a good one. Her Dare to Lead book is like a condensed version of lots of her other books, if that makes sense. So it's like a little taster of a lot of the books she's written. So then if you're interested in what she's got to say, you can then buy another book and explore it in a bit more detail. But there's modes out there. There's some that are a bit less emotional, a bit more scientific based, which might appeal to the more logically minded person.

SPEAKER_00 26:03

So I do think a book that divides the audience is a sign of a good book. If it makes you talk about it, it's probably a good book.

SPEAKER_01 26:11

Yeah, definitely. There was no books that we read altogether as a in our kind of fellowship group that one universally loved, which I think was great, because it just created a bit of discussion.

SPEAKER_00 26:20

Yeah, lovely. That brings me to the end of my questions. I don't know if you have any leaving comments for our listeners.

SPEAKER_01 26:28

The last thing I would say is that although the leadership fellowship was great and I'd recommend it to anyone to have a think about it, you can access a lot of leadership resources during training without doing a fellowship, a bit like you can improve your teaching abilities and get involved in research without necessarily doing a PhD. You can do the same with leadership, and there's lots of opportunities out there. And that might be doing something like achieved registrar post if it's not one that requires you to come out of programme, or it might be accessing some of the free online learning that you can get in the case of Scotland through Weading to Exchange, in the case of Wales, the Gowella platform, the H E I W one, and there's loads of things in England as well, like the Leadership Academy resources as well. So there's loads of stuff out there to access and to explore, even if you don't feel like coming out of programme is right for you.

SPEAKER_00 27:18

Great. Thank you so much, Kirsty. Thank you for taking the time to talk to me today. Thank you to all our listeners for listening. And if you want to hear any other episodes on careers, different specialties, then go to our career conversations site. Equally, we've got clinical conversations for all the clinical conundrums that we can think of. Hopefully, you'll be interested in listening to. Thank you all.