What I wish I knew - Preparing for and becoming a Consultant (7 Mar 2024)

SPEAKER_01 0:00

Hello and welcome to Consultant Conversations brought to you by the recently appointed Consultants Committee at the Royal College of Physicians of Edinburgh. This podcast has been developed to support early years consultants with some of the more challenging, non-clinical aspects of their work.

SPEAKER_02 0:38

My name is Hannah Preston. I am one of the co-chairs of the Trainees and Members Committee and a renal registrar working in Edinburgh. This series aims to support early career consultants, and this podcast has been developed to support the transition between completion of specialist training and starting a consultant post. I'm joined today by Helen Lidicot, a respiratory consultant at NHS Tayside, and Caroline Scalley, a consultant cardiologist at NHS Lothian. And today we will be discussing what I wish I knew, preparing for and becoming a consultant. So thank you so much for joining me today. And I would like to start this podcast by asking really why you thought it was important to create this podcast and episode.

SPEAKER_00 1:27

So for me, I felt this was really important because I, when I got to the end of my training, thought that I was absolutely ready to be a consultant and had no concerns about it at all. And then realized when I started my consultant job that the transition is really big and I was very underprepared for it. I knew during the sort of final months of my training through to my post-CCT fellowship that there was lots of things I didn't know. And I didn't realise I didn't know them until I was right in the midst of applying for consultant jobs and looking for consultant jobs, and then right in the midst of being a new consultant. So for me, I felt it was really important that we tried to develop something that can just give some tips and answer some questions that I wish someone had given me the answers to when I was starting out as a senior trainee applying for jobs or when I first started out as a new consultant.

SPEAKER_04 2:20

Yeah, I completely agree with that. It's really important because you just feel a bit lost. You complete your training and no one's there to sort of support you in finding a job. It's often like really new skills that you're not really used to doing, like really putting yourself out there and advertising yourself for a potential post, not things that you're necessarily familiar with. So yeah, together with the rest of the reasoning appointed consultants committee, I think we all feel really passionate about this subject and that we need to talk about it more.

SPEAKER_02 2:48

Fantastic. I completely agree. I think it's an area that definitely needs a greater awareness and highlighting, especially because it seems very different from applying through your foundation, IMT, then to registrar, which is all kind of nationalized through Oriol. How do you approach finding a consultant post? Because it's a completely different process. If I had my time again, I think I'd definitely say plan.

SPEAKER_04 3:16

And I'd probably plan about 18 months in advance. I definitely had to do a bit of live planning because my husband's also a reservoir consultant and we knew that we would be seating together. So we sort of had to do a bit of live planning. But I think that is a really good idea because it's such a big transition point, and it often comes with, and you don't necessarily have to stay in a consultant post for a long time, but it often comes with the expectation that you are going to be in that post for at least kind of a five-year period for most people. So I think it's probably a good idea to kind of plan out, you know, where do you want to live? What looks like the best situation for you, what would work for your partner and family. I actually sat down and mapped out kind of right, where are my family? Where do all my friends live? Where are the hospitals that have the things that I want to be involved in with subspecialty interests that work for me, work for my husband? And I almost kind of drew a big diagram in my head about what to do because it's a really good opportunity to change and to embrace things. I trained in London. For us, it was a time that we decided to relocate to Scotland. So it was a really big change. So we're in a good opportunity, I think, to reconsider and do some blue sky thinking about what the perfect situation looks like for you, both in your life and in your job. For example, do you want to do acute medicine? Do you want things attached to your job, such as research or teaching, quality improvement management? What's your subspecialty interest like, and how important is that to you? Have a think about everything in your own time and try and then take that forward and start start speaking to people and network and ask people, you know, what's going on, what opportunities are there available. And Caroline might be a bit less of a planner than me.

SPEAKER_00 5:05

So not really. For me, I had it all planned out. I was a trainee in north of Scotland and I planned to stay there. That was the plan. And I went off to do a post-CCT fellowship and a job came up in Edinburgh, and I decided at that point that I fancied a change. And it was a very last-minute decision. The job closed on the Friday, and I think I got in touch with the clinical director on the Tuesday of that week to have a chat with them and go through and see about it. So mine was very last minute. But I think the things that Helen is saying is really important, and I think one of the things that I've certainly seen not so much in myself but in some of our senior trainees coming through, is to decide what your priority is. Is your priority the location? So is it that your family are based where you are currently and you can't move, or it would be really disruptive for you to move, in which case you may have to think about what you're willing to sacrifice in the job. It's not impossible, but it's uncommon that you're going to get exactly the job you want and exactly the place that you want it. And I think it's really important to be realistic about that early on and think about, you know, what is it that's the most important thing for me? Is the most important thing for me that I stay in this area or that I move to this area close to my family? Or are you willing to be a bit more flexible in location? Because what's most important for you is the job plan and what your job entails. And I think often people don't think about that because when you're coming through training, you've got this idea of the dream, and often you do have to make some compromises when it comes to finding a consultant job, especially if you want to be in a specific location. And I think it's important to think about that, you know, certainly within that 18-month period coming up to CCT is what is more important to you, location or job.

SPEAKER_04 6:50

You might find sort of opportunities that you didn't know existed. I know quite a lot of colleagues who really wanted to stay in an area and have almost had a job kind of planned for them, and then actually have looked further afield and realized that the opportunities further afield are actually much more in keeping with what they want. And I think that it's a really good idea to network and explore what's out there, even if you do want to stay in an area, because at least it gives you a bit of negotiating power as well to say, well, look, actually, there's this other opportunity for me. I'm not quite sure whether I want to do all of that acute medicine or whether actually I want to do this job and they're offering me this. I think in the current job market, you are able to negotiate a lot more than you think. Be confident about putting yourself out there and just talk to people. I think one of the things that I found really interesting was that there was no kind of plan. So you have like all these amazing registrars coming up, and actually the organizations in which we work don't really plan to create a job at the right time that fits with your CCT date, even if they really, really want to keep you, and even if there's a job coming up in your subspecialty. So when I was applying for consultant posts, lots of my colleagues were applying for things that weren't their subspecialty interests, which is actually completely fine, and they're really happy having switched their subspecialty interests now, but then say a year later a job had come up in their subspecialty, they'd already switched, and someone else in different subspecialty went for it. It is kind of unplanned in the progression, and we're used to things kind of progressing from one year to another nice and neatly. And I think that actually everything's up in the air, basically. So it's a really good time just to talk to people, talk about all the opportunities that may be available for you and that might be coming up. I think it's quite unusual that jobs are created for specific registrars now. They're more created because it's what the organization needs. So it's a good idea to kind of spread your network widely and find out what's going on in lots of different areas, I'd say.

SPEAKER_00 9:02

And I think one of the key things is as Helen says, speak to people. So if you're in a department and you want to stay, tell them. But equally, people like your educational supervisor, your training program director, consultant colleagues may have friends and colleagues elsewhere. And you may say, Oh, I'm not sure there's not a job here. And they may know someone that is looking for a colleague or is going to be looking for a colleague in six months, and you may be able to have a chat about a job before it's even advertised in a different area. So I think being really honest with the people you work with, contacts within your specialty about what you're looking for, what type of job you're looking for, where you want the job, is really important because you don't know what contacts other people have got. So I would certainly recommend don't be shy and saying to people, I really want a job here, or I really want a job in this subspecialty. Can you put me in touch with someone that's done it before? I think is invaluable to you as your colleagues.

SPEAKER_04 9:56

Yeah, I completely agree, Caroline. I think it should really form part of your penultimate year assessment. And I do that for all of my trainees, but it's not actually often done. Like that PYA shouldn't really be about have you ticked all the boxes that you need to tick. It should really be about what are your career plans, what do you want, how can I help you and support you in this last bit of your training? And it should really be seen as part of training, I think.

SPEAKER_02 10:23

That's really, really good advice. And where and when should people start looking for posts?

SPEAKER_00 10:30

There's the standard places jobs are advertised, BMG Careers, NHS Scotland job website. And certainly the reason I applied from the job that I'm currently in is I was desperately waiting on the job in my old trust to be posted. They kept promising me this job. So I checked every week to wait for it being posted and just saw this job out of the blue. But I think if you see a job advertised and you are interested in it but not eligible for it, approach them anyway. So if perhaps it's a bit soon for you, get in touch with the department. They may have no suitable applicants on that occasion. And what they may do is they may then hold back re-advertising the job until you're ready. Equally, if there's somewhere you particularly want to work. So for example, if you want to go and work somewhere quite rural and you think you know the hospital you want to go and work for, rather than wait until a job becomes available, go and have a chat with them early on because what you might find is that they are thinking of advertising the job and they might be thinking of advertising it in three months, you might not be ready for six months, and they might hold off and wait until you're ready. Most departments are really keen to have someone who's going to come who wants to be there and who wants to be a part of the department. So if you've got someone approaching them saying, you know, I really, really want to work here, this is the lifestyle I want, I want to come and work in your hospital, often you might find they might change their plans or they may adjust things or hold things off just for the right candidate. So even if you think it's too early, or even if you think there's nothing available, then I think speaking to people if you've got something in mind is really invaluable. And I certainly have had a few trainees come through who've gone with that plan to speak to a department that they really wanted to work in, and the department has done everything possible to make a job possible for them at a time that they're ready to apply for it. So I don't think it's ever too early to say, and I think from a point of view of where to look, I think there's the standard places, but just chatting to people that you know you like that department or you want to work in that department can often just come up with something that was unexpected.

SPEAKER_04 12:32

Often when the job's advertised, then maybe advertising it for somebody that they have in mind as well. That it's useful to bear that in mind, but not be put off by that. So I was really worried about applying for a job in a place that I knew nobody. And I came up and spoke to lots of people in Scotland about working here and had a really nice chat with them about what I'd done and what I wanted to do. But it was still quite intimidating applying somewhere where you feel, oh gosh, there's probably other candidates locally that they want to give this job to. And I think it's really, really important not to get put off by that because you've got to have confidence in your own abilities and definitely go and talk to people, let them know who you are and what you've done. Many, many times I've seen people who have been in line for a job and it's gone to a different candidate who's come from elsewhere. So don't be put off if you see this advert and you're worried that there's somebody already hit for that job. Some job descriptions can be really descriptive and you can read it and think, I know who that job's been designed for. And actually, it's really important not to get put off by that, but also to remember that there might be other jobs coming out. So I've heard of lots of circumstances where people have applied for a job. The job description pretty much was written for somebody else and they knew that. And then actually they created two jobs, or another job then came up in three months' time and they got to know that person. So I think, yeah, keep an open mind and just go for it. Go for what you want. This is very different when I applied, but there are a lot of consulting posts vacant just now, especially in places that are really struggling to recruit. I know that they are talking about giving people sign-in on bonuses and that there is a negotiation that you can make about starting on different nodal points in your consultant salary. I wouldn't go in with that as a first hit, but I think it's important for people to know that these jobs where there are kind of signing on bonuses are becoming more common, especially if you're sort of working more remotely. And I think it's okay to have these conversations about what you want, um, to talk about relocation expenses if you're going to relocate, if there's a huge amount of travel involved in your job, to have a discussion kind of early on about whether you'd get time within your job plan to do that travel or the costs involved for that travel. It would happen in other jobs if you were a lawyer or working in the city, you'd have these conversations about signing on bonuses and things like that. I don't think you should be too put off by doing it in Menton, but obviously it's probably not the first thing I've discussed.

SPEAKER_00 15:08

One of the other things sort of along that line is job plans are flexible. So you will often see a job advertised and it will have a sample job plan. I would recommend that people don't get put off if the job plan looks terrible because your job plan will evolve. I came in and started training in something that I'd never done before as a consultant. I decided I didn't like it, so I don't do it anymore. So my job plan has evolved in two ways, really, since I started. I took something on that I hadn't expected to, and then I got rid of it again. So your job plans are negotiable. So if you think, well, actually this job plan's got four clinics in it, I don't want to do four clinics, that's probably negotiable. So I wouldn't be put off if you see a job plan that's not perfect or looks like I don't really like that, it does change. I think that's a really important thing when you're thinking about consultant jobs, is don't be put off and don't be put off by the job description either. Because as Helen says, sometimes it's written for a person, and actually often if someone else applies for the job who they think is a better candidate, even if they don't quite match the job description, you know, the person's specification specifically, they will often overlook that. You know, you may feel, oh actually, I don't quite fit that specifically. If it's a job in an area you want and a specialty you want, again, I wouldn't let people be put off. All these things are very flexible in medicine.

SPEAKER_04 16:24

I think it's having that conversation. But I definitely wouldn't leave it till you're in the post to try and change your job plan too much. I try and have that discussion much, much earlier on and definitely kind of double check what's on offer. So if you're going into hospital that says, oh no, this is what all consultants do, all consultants have got this in their job plan and that's non-negotiable, and definitely do some digging around and find out whether that is the truth of it and actually how much flexibility there is in that because you do want to start on a high and you want to start with something that you are happy with the job plan. There's a separate podcast about job planning all on its own. But yeah, I definitely, definitely negotiate and have a conversation, like Caroline says that's really good advice.

SPEAKER_02 17:11

Thank you. And in the last year of your training, when you're at that senior registrar level, trainees often feel that they're itching to move up and gain those kind of transitional skills. What advice would you give to, I guess, yourself looking back when you were in that final year of training?

SPEAKER_04 17:31

Yeah, I think it's a really difficult time. And also depending on what you've done, so like by the time I'd got to that point, I'd had several lots of maternity leave, I'd done like out-of-program experiences, and like all the people that were like medical students were coming up and becoming registrades, and I was like, I'm so done. I really want to move up and progress and start making the decisions and do what we've been trained to do. You really do feel that itch. I think it's a really useful time, and definitely planning some time to act up in a consultant role is really, really helpful because all of a sudden, when you're making the decisions and the responsibility stops with you, including the actions of the whole team. So what everybody's doing is then your responsibility, it does feel very different. And it's a really nice time to sort of have some role playing, which is supported and it should be supported. So you never should be acting up without a plan to kind of discuss cases with consultants and to support you in that transition. But I think it's such a useful experience to sort of say, okay, I'm going to pretend that I'm in charge today, but not really. And it's really good to say, okay, actually, this is my experience on this ward round. I found that really difficult, wasn't sure about that, and then to go and talk to somebody about that. I think it's really important. So I've seen lots of different things in this period. I've seen quite a lot of people get very sort of frustrated and a bit annoyed that they're still registrars and sort of slightly ruin relationships at the end of training posts, especially with consultant colleagues and possibly other registrars. So I'd say not to get frustrated and just continue to be kind and remember that the consultants that you're working with are going to be your referees. So you want to leave on a good impression because you want them to give you a good reference and you might want to come back. And also don't get lazy and overconfident because it is actually a time where I've seen a lot of people make quite big mistakes because they are in this zone where they think, you know, I've nearly done my training, I know everything, and that can also lead to problems right at the end. So I'd say just try and relax and use the time in a different way, even though it can be a bit frustrating, that last hurdle.

SPEAKER_00 19:55

Yeah, I think that's great advice. I did my PhD between ST6 and ST7, and I stayed on the on call rotor during my PhD. So I was a senior cardiology trainee for five years. So by the time I got to ST7, I was done. I was ready and I thought I knew better than everyone. And I had some very difficult conversations with some of my consultants. And you know, for me, it was a really good time to get that feedback actually, you know, for my TPD to sit me down and say, You're upsetting people, you don't want to leave on a bad note. And what I learned from that is that I very much am someone whose emotions are very at the surface, whether that's good emotions, bad emotions, and the fact that I was frustrated and done was very apparent to everyone who was working with me, including the consultants and the other registrars. And I realised how important that was to try and deal with that and ways in which to manage that. And that was feedback that I got in my final year. So I think actually when you're about to go from being a registrar to being a consultant, that there's lots of things that change. It's not just about the clinical skills that you've learned and developed through your time. A lot of it's about your teamwork and your leadership skills. All of these things are really important. Your interpersonal skills become really, really important when you're a consultant. And actually, in that ST7 year, taking that time with my TPD, with my educational supervisors to talk about these things and to talk about some of the things that I was good at in my interpersonal skills, but also the things that actually did need a bit of development. And it was really nice for me to get that feedback and realise that actually I'm upsetting people here because and this isn't what I want to be, and I don't want to be this person going on to a consultant job was really good for me to sort of sit and take stock of things and think of ways in which to deal with it. And I think that didn't really happen, but I didn't really realise that until I was at that stage. And equally, I just think that perhaps educational supervisors and TPDs didn't feel that they could give me the same feedback as a more junior trainee. But once I got into my final year, I think they felt they they knew me better. They felt much more confident being able to give me that feedback. I really did find that completely invaluable going on to a consultant job.

SPEAKER_04 22:08

Yeah, it's such a good learning opportunity that I don't think you'll ever get again because all of a sudden people start seeing you as their potential colleague. And the importance of how you come across to people and the impression that you give to people suddenly becomes really, really important. And it's not at other times necessarily during a training because you're just sort of jumping through all these hoops. And actually it's all, like Caroline says, I completely agree. It's all the skills that you worry about being clinically competent and you know, are you going to get the diagnosis right? But actually, it's all the other stuff like teamworking and dealing with conflict and leading your team and inspiring your junior colleagues that actually is the hardest part. I definitely sort of seek that feedback from educational supervisors. Then I actually made a list. You can tell that I'm like the planning listy one, but I actually planned that one and wrote. You know, there were so many really inspirational consultants. And I wanted to kind of capture, you know, why I found them really inspiring and what I wanted to take forward from these people that I'd work with. And then obviously there were a few examples of things that I didn't want to do. And I made this what kind of consultant I want to be list that I then looked back on kind of 12 months later to sort of say, okay, actually, that's gone quite well, but maybe I need to work on these things. It was really helpful and also really nice to reflect on all the inspirational figures that you've had in your training and how they've influenced you. Probably they don't know that they had that influence on me, but all of those things that you take away from the way that your senior colleagues kind of interact with patients in different ways.

SPEAKER_02 23:52

Those are really good messages to go forward with, and I think definitely things that people can reflect on and look at and work out how they want to navigate that year. Now, Caroline, you mentioned that you did a post-CCT fellowship, and I think they're definitely becoming more common or more appealing to people. So it'd be really good to get both of your thoughts on post-fellowship CCTs.

SPEAKER_00 24:18

They're really common in cardiology, the vast majority of cardiology trainees go and do a year either sort of towards the end of their training or after. And I did mine post-CCT. So I trained in heart failure and devices. And although I'd spent quite a lot of time being on call and felt really confident in my sort of general cardiology decision making, the actual practical device stuff I felt a bit uneasy with. I felt, you know, as I was sort of into ST6 or during my research period sort of coming into ST7, I really did feel that I wasn't going to be ready to be in theatre on my own doing these procedures without backup. So I decided to do a fellowship in heart failure and devices with sort of advanced heart failure transplantation. I don't think I had the best experience because my fellowship happened to extend into COVID and not very much happened during COVID. In a transplant centre, we were kind of kept away from all the immunocompromised patients or the really sick heart failure patients. But for me, it was just about extending that period a little bit, about sort of getting off the conveyor belt. So I did everything the way you're supposed to. I did FY1, FY2, straight into core medical training, straight out of core medical training into a registrar job without any time in between. I did my research in between and then I sort of felt I've not done anything different. I stayed in the UK to do mine because of family commitments. I couldn't really go abroad. And I thought it was great for that sort of experience, you know, doing advanced heart failure, learning about L VAS, learning about ECMO, you know, that kind of thing. A lot of my colleagues have done them, a lot of my friends have done them, and they've gone abroad and often they've taken their family. So as well as having that sort of experience, you know, the clinical experience, often it's just a lifestyle experience. It's doing something a little bit different before you become a consultant and before you take that consultant job on to do something a little bit different. It gives you a year of slightly more responsibility, but you're still not the consultant yet. So, you know, I thought mine was really valuable. The other reason I did it was I had planned to stay where I trained. One, there wasn't a job ready for me, and two, I just thought it was really important to go somewhere else so that I didn't end up being ingrained in the way things were always done. And actually for me, it was really useful because it made me realise that I didn't really want to go back to where I trained. And I think if I'd not done my fellowship, I would have just taken a consultant job in the hospital I trained in and still be there and not know that there was anything different out there, whereas actually being somewhere else made me realise actually I might not want to go back there and I want to explore what other options are available, which has been a great thing for me.

SPEAKER_04 26:57

I think generally there's never any rush because once you're in your consultant post, it is a long road. And whether you take that time out within training to do out-of-program experiences, kind of incorporate sub-specialty experience within an MD or a PhD, or different types of experience like management or QI, which is what I did. I think yeah, it's about broadening your horizons. And yeah, I definitely advocate for getting experience in different centres because it really does make a difference. I think to your approach, being in sort of small areas where you're going to be working with the people who've trained you, who might have trained with you at medical school and you know, everyone knows each other, does have some benefits, but it gives you a much broader experience if you've been to lots of different centres and you've seen how other places work. It's not so common in respiratory medicine to do post-CCT fellowship, but I think it's such a good idea, especially if you want to develop the subspecialty interest. However, I'd say that it's absolutely fine to keep your sort of C V Pluripotent. I've known a lot of people who've developed a very specific subspecialty through their PhD and post-PHD research and ended up being a completely different specialist and been really, really happy with that. And you don't have to really start off your consultant post kind of knowing how to do everything. So I know lots of consultants who started off, for example, not being able to do some advanced bronchoscopic procedures and then developing that training while they've been in post or developing any kind of subspecialty service. You know, you are supported by your colleagues and there is opportunity to develop a subspecialty interest while you're in post. But I think that's probably just because they're not available in respiratory. So I think it will become more common. It's not always the easiest thing to do. Our surgical colleagues do this a lot more, and actually it can be hugely expensive to develop all these subspecialty experiences. So it might not be for everybody.

SPEAKER_03 29:02

But if they are available and it's something you want to do, then just go for it.

SPEAKER_00 29:06

I think the other thing to say is, you know, one of my colleagues really wanted to learn Tavi and there wasn't a Tavi fellowship, so he approached the centre in the UK that has the biggest Tavi output and asked if he could go there. Now, to be fair, he went 6008, which not everyone can do. His wife was already a consultant, so they were able to manage that financially. But there is funding out there, and while there might not be a specific fellowship advertised, if there's something you really want to learn in a centre you really want to learn in, don't be afraid to approach them. Certainly in cardiology, a lot of the device companies have money there to be able to sponsor these fellowships. You know, if there's something you really want to do post-CCT and there's not a fellowship already there, you can create one. But equally, as Helen says, don't worry if you've not managed to do that because you can learn some special things as a consultant. I did a post-CCT fellowship and then came as a consultant and started learning device extractions, which I'd never done before. Now I've now stopped doing device extractions because I realized it wasn't for me, but that was an opportunity that I had as a consultant to learn a completely new skill. So I think they're great if you want to do one and you can do one, both financially and family reasons, but equally, if you can't do one, I don't think it makes that much difference in the long term.

SPEAKER_02 30:18

That's really good to hear both sides of having had experience of one and not. So it would be really great to hear both of your experiences about becoming a consultant. How did you feel? How did you navigate that first part? And looking back, is there anything that you really reflect on?

SPEAKER_04 30:39

Yeah, I think it's really exciting. I was really, really excited about becoming a consultant because you're finally doing the job that you've been trained to do. But it's a lot of newness. It's like starting any new job. It's quite exhausting. You might be working somewhere that's completely new, systems and processes might be completely new to you, and it's a time of huge growth and change, and it is also very challenging. I think I was so excited about it that I didn't really realise how challenging it was going to be, and probably should have been a little bit more prepared for it.

SPEAKER_00 31:11

I don't know what you think, Caroline. So for me, I started my consultant job in a new city, in a new hospital, right in the middle of COVID. I remember sitting in the car park on my first day for about half an hour, willing myself to actually go in and meet people. It was quite scary. Obviously, it's different if you're working somewhere that you've trained. I wasn't. So it was really quite a frightening experience. And I think in the weeks leading up to it, I was really excited. And then on the day it all sort of hit me all at once that I was quite terrified. So I had an odd experience because I didn't really have a proper job plan when I started. We were all doing sort of a COVID job plan and it didn't quite feel real, I think. So it took a good sort of six months before I was actually working to my job plan rather than the COVID job plan. But you do realise very quickly just how important your interpersonal skills are. Often the clinical stuff is easy. You've trained for it, you've spent a long time doing it. Clinics were similar to clinics I'd done elsewhere, there wasn't much different, the patients were the same, but the things that you didn't realise went on in the background when you were a trainee become more apparent. Things like complaints, you are expected to deal with complaints. If that complaint is about you, if that complaint's about your trainee, if that complaint's about the nursing staff, if you're the named consultant, that comes to you and I hadn't quite appreciated that as a trainee. The other thing is just how important it is to have good colleagues. I went into a department where they'd never had a female consultant before and had expectations of that and actually found that the people who I expected to be not so supportive were incredibly supportive and looked after me and welcomed me with open arms. And some of the people who I thought would be more supportive weren't I think becoming a consultant has ups and downs. Essentially I started medical school in 2000, so I've been training for 20 years for this job, and all of a sudden I was getting to do it, and there's that excitement, and there's that excitement of being the boss and being the consultant, but equally it is new and quite scary. It definitely had its good points and it's not so good points.

SPEAKER_04 33:22

I think it's really interesting the idea of colleagues and being part of a consultant team. Some consultants that I knew that perhaps weren't even the best consultants when you were a trainee suddenly became incredibly supportive and offering lots of advice and really good colleagues. And then actually there were other behaviours that I found quite interesting and really unexpected. So, for example, there were quite a lot of more senior consultants, you wanted to learn from them, and they had a huge wealth of experience, very much made you feel like a new consultant and like you didn't really know as much of them, which wasn't really very helpful. Yeah, you are new, but you got your CCT, you know what you need to do to do that job. And it's always nice to sort of feel supported rather than the youngest of a bunch. But even more colleagues that haven't really CCT'd much earlier than me, there was quite a lot of sort of territorial behaviour, I'd say, and at times slightly undermining behavior. I can remember one of the other consultants in the middle of the acute medical unit started giving me like a lecture. I think this is on my like first or second week, about the causes of hyponeutremia. And I was like, Yeah, I know all the causes of hyponeutremia. Why are you quizzing me on them in the middle of this open environment? And it was really bizarre. I think this can happen even if you do know people, that people have different behaviours towards you as a colleague compared to when you're a trainee. And you are quite protected when you're a trainee because you've got an educational supervisor, you have quite a lot of power as a trainee. You kind of lose some of that when you're a consultant, in that you haven't really got anyone that has your back and is responsible for your welfare, I'd say. I think that's a really, really big important difference when you're a consultant. You've got your colleagues, but you haven't got anyone who is directly responsible for your progression. You're much more of an independent actor in that sense. Trying to navigate some of these, I found slightly strange behaviour. So I just thought, I don't really understand why it's necessary to do that. It was really quite interesting. And I think it's really important to find your supportive allies and kind of just ignore that rubbish behaviour. Like if people are being territorial or difficult or making you feel crap, then just ignore that and focus on people who are supportive allies. I'd say find yourself a mentor. Within your hospital, it's quite good to find a mentor, especially if you're in a new place. I found that really helpful to try and navigate who was who, what was going on, who I needed to speak to to get stuff done. And then also outside your organization, having another mentor is really, really helpful to try and kind of bounce ideas off and do a bit of coaching with. I think that becomes really, really important because you haven't got these kind of set points of educational supervision that you're used to where you can discuss how it's going and you lose that support really. You've got to kind of find that support yourself.

SPEAKER_02 36:34

Did you seek out someone for that role or did someone approach you and fall naturally to be your mentor?

SPEAKER_04 36:41

Yeah, again, it's really interesting because actually that came up as part of the planning for this podcast that people said, you know, actually ask that question at your job interview. Like, what does the organisation provide for new consultants? Is there a mentorship scheme? Because it's not actually there in a lot of places. I'd say there's really good resources through the Royal College of Physicians of Edinburgh, and that's kind of where I found a lot of support through the recently appointed consultants committee and through the mentorship program that the RCPE runs. I found that immeasurably helpful. And also seeking out lots of new information to try and help you overcome those challenges or trying to get more education about how to deal with conflicts and how to deal with complaints so that you can help navigate those things when they happen. But I think you very much have to seek it out yourself at the moment. It doesn't often form part of the job package. But I'd say put that structure around you because it's really, really important for your well-being. And often if you're in a new place, never worked there before, you have to really find people that you trust and you want to form those long-term relationships with colleagues that you have a trusting relationship with. And sometimes it can take a little bit of time to actually suss out what's going on, which I think would be one of my kind of biggest tips to myself of not diving into a situation with enthusiasm, although it's great to be enthusiastic, but to actually kind of sit back and say, okay, I'm gonna be here a while, I've got a bit of time, I'm gonna suss out what's going on here, and almost think a bit more politically about it, like what's going on in this organization, who are the players, who gets things done, who's a bit grumpy, who's really nice, and just sit back and watch a bit. Don't feel like you have to make too many decisions or change too many things immediately, which is quite difficult for me because I'm like quality improvement person. So I like to come in and like kind of change and improve things and make things better. And I did hold myself back quite a lot in terms of doing those things because I knew that shooting into a new organization and gesting lots of new ways that they could work probably wasn't a good idea. But even though I did hold back, I think that I probably could have held back a bit longer just to kind of see where the layer of the land was.

SPEAKER_02 38:55

That does make sense, and that's really a good bit of advice. Did you have any fears about becoming a consultant? It's obviously exciting but scary at the same time. So was there anything specific that you were fearful of? And if so, how did you overcome those fears?

SPEAKER_00 39:10

I think my fear really was that you were going to be on your own. You know, you sort of think once you're the consultant, the buck stops with you and all these decisions are gonna fall to you. And what if you've got a really complicated case and you've got to make decisions and it's not straightforward? And I went to work in a hospital that I'd never worked in before. A bit like Helen, I'd never set foot before, and they put me on call for my second week. I was the CCU consultant on call just to throw me in at the deep end. And I did have that fear and I learned very quickly that you are never on your own as a consultant. And that's one of the key things that really changed the way I looked at my job. You have so many colleagues with such vast experience. So you'll have colleagues that are relatively close in the sense of they've been a consultant for a similar time as you but have maybe different experiences, and then you'll have consultants that have been around the block for 20 years and have seen everything. A lot of these complex patients are discussed at MDTs. In my department, we have two formal MDTs every week, not including the informal little MDTs where you just go and find a pal and have a chat with them. And I think being thrown in at the deep end and doing the CC on call actually was really good for me because it made me realise really early on that I'm not on my own. Yes, my name might be above that patient's bed, but the buck definitely doesn't stop with me. And I've got so many people that I can ask opinions and advice from, and that a lot of these very complex decisions are made by a team and not by a single person. And that really allayed my fears very early on about that sort of buck stops with me situation. And that was definitely my biggest concern about being a consultant.

SPEAKER_04 40:47

You don't see all the conversations that go on behind the cases, and I'd echo that there's so many things and so many different subspecialties as well. So, you know, somebody you might be on call and have a patient, but actually it's not your area of subspecialty. And we do talk all the time about cases. I definitely felt the same. For me, it was about the kind of clinical competencies that I was most worried about. I was really worried about making mistakes, which is completely normal when you first start. And you're probably much more kind of risk-adverse when you first start as a consultant rather than when you become more senior, I think you are kind of slightly happier taking risks. And along with that, it takes a longer time to do things if you are more risk adverse and sort of double checking everything. And you need to give yourself enough time to sort of work out where your comfort level sits, and that's fine. I was really worried about making mistakes. I think mistakes in general, because I thought, okay, I'm done, I'm a consultant now, I should be getting it all right. And I think I've probably put a lot of pressure on myself to get it right in a lot of different ways. And actually, it doesn't matter if things go wrong, things will go wrong, you won't get it right all the time, and it's just all about learning and definitely asking for support. I think the things that I was worried about most weren't actually the hardest things when we started. I mean, we've talked about all of the like dealing with complaints and suddenly becoming kind of in this leadership role, dealing with trainees in difficulty, dealing with difficult colleagues, I think these were the problems that I found most hard. It wasn't actually the clinical decision making at all. That was actually the easiest bit.

SPEAKER_02 42:29

Taking into account what your fears were and how you found becoming a consultant. What would your advice be to colleagues in those first few years that you found really useful? Or maybe you thought, oh, I wish someone had told me that.

SPEAKER_00 42:46

I think the most important thing is to find a pal. So find a friend. And that was what made the biggest difference to me. So I found someone who was actually fairly close in stages I was. So I'd been a consultant for around 10 months when I started. So had been through all the things that I was going through and really was able to help me navigate those and help me, what did you do? And oh, I don't have a computer yet. How did you get your computer? Oh, who do I speak to about that? Those little things. And also someone that I could go to without feeling embarrassed, you know, I don't know what to do about this patient, or I don't know where the change in rooms are. Really little things. And just to have someone that you could go and ask all the stupid questions was really important actually for me. I found myself sort of two friends quite early on, one who was close to me and could just answer all the stupid questions, and someone else got a lot more senior than me and had been a consultant for a long time who was able to sort of give me that advice about what do I do when I get a complaint? What do I do when, you know, I've seen this patient. I'm really worried I've done something wrong, I'm really worried I've missed something. What should I do? Can you reassure me? You know, someone really just to go to when I was having a bad day. That is definitely what has got me through. I'm now sort of three and a bit years in and those people have got me through those sort of transition period definitely.

SPEAKER_04 44:07

Yeah, I think that's really true. You're not alone. So kind of these feelings that you have, even though you are acting in a much more independent role. But you're never kind of alone in thinking or feeling things, I think. So it's always good to find someone to talk to about whatever it is at the time. I think that's really important. I think not saying yes to lots of things initially, when you start your job, it's a bit strange because it does feel like you've got lots of time because you don't really have a huge backlog of emails and you don't have a huge number of projects that you've got on the go. You're probably still sort of working out what additional things you're doing in your job plan, like teaching and training, quality improvement and those sort of things. And then all of a sudden you say yes to lots of things because they all sound like really great opportunities, and then you're really, really busy. So I think I'd take the time to consider what opportunities there are and what you want, and don't take on things too quickly. And there are quite a few things that might be really fun for some people, and maybe it's just different tastes, but there is this sort of thing that happens where someone's like, Oh great, I don't want to do that anymore. There's a new consultant, I can give it to them. They've got loads more time. It's not really like dumping of work because someone might really, really want to do that piece of work and it might be great for them, but it is worthwhile just taking your time to consider before you just say yes to lots of opportunities, I think.

SPEAKER_00 45:33

Yeah, I would absolutely second that. I said yes to everything that was offered and found myself about 18 months in absolutely swamped outside of clinical work. You know, I took on writing a website, organising training courses, and before I knew it, I was at work until eight o'clock every night and had no downtime. Opportunities will continue to come. I was of this fear where if I say no to something, no one will ask me to do anything again and I'll miss out on all of these things. And that's not true. There are so many opportunities. One piece of advice I would give to someone, it would definitely be that do not be afraid to say no, because you will just say yes to everything, and as Helen says, just end up realizing just how busy being a consultant actually is without all these extra things. So when you take those on, it does become sometimes quite overwhelming.

SPEAKER_04 46:21

I guess it is always so busy. And I sort of do this with my quality improvement work anyway, but I think it is really good to make a plan and actually sit down at the beginning and think, okay, maybe don't promise yourself too much, but sit down at the beginning and say, my first year or my second year, what do I want to do? What do I want to achieve in the next 12 months? And how am I gonna get there? Because it's quite nice to sort of look back at that and use that to drive forward what you want to get out of your consultant place. I think that's really, really helpful.

SPEAKER_00 46:54

And I think the other thing is don't be afraid to not have anything extra on the go. I think as a new consultant, you do have this sort of, oh, I must be doing all these extra things. You know, I've got my job plan, I've got my clinical, I've got my SPA time, but I must do all these extra things on top. There's nothing wrong with having a period, whether that's six months, a year, two years, five years, whatever, where actually what you're just doing is your clinical job. And looking back, I really wish I'd spent a couple of years getting my feet under the table as a consultant and getting used to being a consultant before I took on a lot of extra things because actually the transition is difficult and it becomes much harder when you've got lots of other things. So I think don't sit there and be worried that oh, actually I've come to the end of my first year and I've not done anything extra, all I've done is my actual job. There's nothing wrong with that, and that's okay. And it's important to have a bit of time to get used to that and you don't always have to be doing extra things.

SPEAKER_04 47:47

Yeah, the drums are hard enough and rewarding enough. I wanted to say that I think the focus initially should really be on a lot of personal development, and some people might have done more of this than others during their training. If you've done kind of QI and leadership stuff within your training, then you might have done kind of things on personality profiling and networking and stakeholder mapping and all of these things. But I think actually those things become really important when you're a consultant, and I think it's really important to develop reflective practice and work out personally how you want to develop in those a lot of problems that happen initially are often a lack of thought and just generally trying to be kind. I think if you can go into things to say, okay, I'm just gonna think kindly and be kind to people, then that gets you through a lot of things. For example, like in my previous job, some of my colleagues who'd CCT'd before us and became consultants in the same trust suddenly started being very bullish about their seniority to their colleagues who had only the week before been their registrar buddies. And you're just like, why don't you approach a new job by making that stance and being kind of really powerful in your position? So I think it's really important to think about leadership and to think about what type of leader you are, how you give feedback to your trainees, how you work as a team, and to read around that, but more importantly, reflect on how you want to manage those situations and just learn and develop in that way. I think often we don't put enough thought into that.

SPEAKER_02 49:31

To round things up, what would your take-home messages be? And what are kind of your golden nuggets of advice for people who have listened to this podcast and where they should go from here, really?

SPEAKER_04 49:48

I'd say talk to people in terms of networking to get a job that you want, but also continuing to talk to people and building up your mentorship network to keep yourself sane and happy.

SPEAKER_00 50:03

I would say that remember that no one gets it right all the time. There's not a magic wand at CCT that means you're never going to make a mistake or get something wrong. And that's normal, and you should forgive yourself when you do get things wrong, because inevitably it will happen, but that's okay.

SPEAKER_04 50:20

And yeah, for me it have to be focus on personal development. You don't have to get it right all the time, but try and grow and develop all those soft skills that are really important. It's often not just about the job that you do, it's about how you make people feel. And that's really important.

SPEAKER_02 50:37

Well, thank you so much for giving up your time and going through all of this. I think it's been really insightful and useful, and hopefully all the listeners will think that as well. And we'll probably try and just create some useful links that can go into the show notes that listeners can click on to find more information or support or access points that we think might be useful. And hopefully, people will carry on listening to the consultant conversations for other podcasts that are applicable to them. So, yeah, if you can like it, subscribe, share with your friends and colleagues, then that would be fantastic.