Training options during the COVID-19 pandemic

The current coronavirus pandemic has affected numerous aspects of life in the UK. For many doctors, this has meant significantly increased workload. For some, it has meant disruption to training programmes, cancellation of exams and interviews, or redeployment to an unfamiliar role. As the situation has progressed, many interviews, meetings and reviews are being conducted via online video conferencing. The GMC and AoMRC have also said they are determined to ensure the longer term needs of doctors in training are not compromised. New or demanding situations mean proactive skills development is as important now as ever.

At Oxford Medical we remain committed to supporting your professional development while at the same time protecting the safety of our delegates, tutors and partners.

What training options are Oxford Medical providing?

As we move into the next phase of lockdown being lifted, we offer three distinct format options to support your development for you to choose from:

  • Virtual Training Room: All courses scheduled for our Virtual Training Room are running as planned.
    • These courses provide you with an interactive group-learning experience facilitated by an appropriate tutor from our faculty via secure video conferencing software.
    • They provide you with an identical CPD accredited certificate as you would receive if you were to attend the same course at a physical location.
    • Click here to see available dates for courses on interview preparation, communication, teaching, leadership and management skills.
  • Online Courses: Availability of our full range of CPD accredited online courses continues as normal.
    • These modular courses enable you to learn whenever you want, wherever you want and at your own pace.
    • Subjects now include interview preparation, communication, teaching, leadership and management skills.
    • We also offer our online courses collated together in bundles which both save you money and broaden your learning experience.
  • Courses at locations across the UK are scheduled to restart from early July.
    • We describe our plans and precautions being taken regarding these events further down this page.
    • Click here to find your course, check available dates and book your place.

We have been able to continue delivering excellent standards of service throughout the lockdown period. This has included providing appropriate solutions for doctors whenever plans have had to change. Read our unedited reviews on TrustPilot.

So, you can book future course dates with confidence, knowing that if you are unable to attend a course due to illness, or changing rotas, or if we have to cancel your course for any reason we will continue to offer a range of alternative options. This includes a free transfer or a full refund.

What safeguards have Oxford Medical put in place?

Courses where delegates attend together in a physical location will only take place in a format which is considered both safe and acceptable and within the latest guidelines published by the UK Government. These guidelines have potential to change at short notice. So we have taken the following steps based on information currently available:

  • We have increased the number of courses which are scheduled to run in our Virtual Training Room as these are unaffected by social distancing requirements.
  • For courses at physical locations we have reduced maximum numbers and, on some occasions, changed to a larger venue.
    • This increases likelihood that the course can proceed while still respecting any physical distancing rules between delegates which are applicable at that point.
    • We will only revert to normal numbers if guidance makes it clear that this would be acceptable.
  • As a contingency plan, if we are unable to effectively, safely and ethically deliver the course at the intended venue then we will change to a suitable local alternative or deliver the course in our Virtual Training Room on the same date.
    • We will endeavour to give as much advance notice of changes in plans for running any courses as we can.

What if my course gets cancelled?

As mentioned above, our intention is to replace any course which we are unable to deliver at a physical venue with an equivalent version run in our Virtual Training Room. This interactive format provides a group-learning experience facilitated by a tutor via secure video conferencing software. We cover the same subject matter and the course has the same accreditation. You would therefore receive a CPD certificate of attendance which is identical to the one awarded for a course taking place in London, Birmingham, Manchester or any other city. This has proven to be a well-received solution by the majority of doctors whose arrangements have been changed in this way.

If, for any reason, you believe this is not a viable substitution for you then you will be advised of your options which will range from transfer to a date later in the year, partial refund with access to a relevant online course through to full refund.

When will you update your advice?

We will continue to update the information on this statement page as and when there is any change in the advice issued by the UK Government.

Stephen McGuire – Managing Director

Herd immunity to groupthink?

Cartoon image of a herd of animals

When we are debating an issue, loyalty means giving me your honest opinion, whether you think I’ll like it or not. Disagreement, at this state, stimulates me. But once a decision is made, the debate ends. From that point on, loyalty means executing the decision as if it were your own.” So said Colin Powell. He was the four-star U.S. General who became a popular figure to quote for leadership training in the first decade of the 21st century. It makes sense, right? But now sit his words beside those of astronaut Chris Hadfield. “There is no problem so bad that you can’t make it worse!

Hadfield ventured into space three times in his career with NASA. He used this phrase to great effect during a talk he delivered on TED. It’s basically an update on the old adage that, “If you’re in a hole, stop digging!” Unfortunately, “no problem so bad that you can’t make it worse,” is a sentiment which those involved in space exploration have learned at great cost. They have learned from tragedies which have, rightly or wrongly, been blamed on problematic groupthink.

What is groupthink?

People connecting with each other, creating consensus of beliefs, what is right and wrong with positive peer pressure can provide a solid foundation for the development of a community or team. It can create a virtuous circle of improvement, achievement and wellbeing.

However, ‘groupthink’, as defined by Irving Janis, is a problematic mindset where tribal instincts where desire for belonging and expectations of conformity spiral out of control. The ‘echo-chambers’ which can develop in social media are a good example. Participants can become close-minded, hearing what they want to hear, rationalising all information and events as evidence which reinforce their beliefs. They may even reject conflicting facts as ‘fake news’ or a hoax. Members of the group then typically fall into line and avoid rocking the boat rather than question the obvious. A bad problem can get worse and worse as participants become more and more deeply entrenched.

There may well be a broad range of contributing factors. However, groupthink can develop quickly and easily. Our tribal instincts of needing to belong can drive us toward thinking in terms of “them and us” faster than we often realise. Last year, the GMC identified a set of problematic subcultures which exist within the medical profession. Subcultures can grow around divas and/or patronage of certain individuals. Factions develop. Groups of people who feel embattled can collect together, reinforcing each other’s feelings of pressure and hopelessness. Some groups can become insular and detatched, their practices increasingly deviating from accepted standards but are convinced that they are doing the right thing.

Risk points

The problems of groupthink can become greatest when the stakes are highest. It may become acute when time pressures are intense, when there are conflicting demands or when there is a lot to lose. This loss could be physical, emotional, reputation or about resources. Concerns over loss of resources can include time having been wasted, need for unexpected additional time commitment or finances.

We may become closed to new information or fail to speak up when there is a state of urgency. We may not want to hear what we need to hear when the message means having to admit we got it wrong. And we may argue against any idea if it means undoing a great deal of work where we have already invested time and energy – even when tat idea makes perfect sense.

So here’s the flaw in taking Colin Powell’s words at the top of this page out of context. “When we are debating an issue, loyalty means giving me your honest opinion, whether you think I’ll like it or not. Disagreement, at this state, stimulates me.” Such an approach is an excellent groupthink preventer. However, “From that point on, loyalty means executing the decision as if it were your own,” must come with some caveats. Commitment is commendable, but these words can easily be interpreted as, “we will now be resistant to new information.” That would be a dangerous groupthink catalyst.

Developing herd immunity

There is no problem so bad that you can’t make it worse!” Time and the inevitable inquiries will tell if the “herd immunity” approach to dealing with the COVID-19 pandemic was ever the government’s original policy. Was it this approach that made the bad problem worse? Did it have it’s roots in groupthink? Or could it turn out to be the only solution after all? Let’s park that debate and think of herd immunity in a different context.

Herd immunity – where enough members of a community are resistant to something – is an interesting concept to think of in relation to problematic groupthink. If enough members of a team are willing and able to challenge beliefs, point out the issues, listen to inconvenient truths and at the same time stay true to their values then that team will collectively develop an immunity to groupthink. Achieving this requires all members of the team, from most senior to most junior, to develop excellent team communication skills. It is dependent on every member being able to engage in difficult conversations in a constructive manner. People have to be able to speak up if they can see a problem – even after the decision has been made.

What are you doing to help develop herd immunity to groupthink?

Stephen McGuire – Managing Director

Getting the most from video conferencing

Someone falling asleep on a video conference

The pandemic has impacted our lives in dramatic fashion. Some of these many changes will be transient. Others are likely to be fundamental with our perceptions, values and behaviours permanently altered from the previous norms. One notable phenomena is the acceleration of video conferencing across the globe. Families, friends and businesses are keeping in touch via Skype, Zoom, Webex, or any of the other digital platforms which facilitate people getting together. These programmes have been around for a while but have constantly developed and become increasingly effective in recent times through improved internet and WiFi connections.

A change in healthcare

When it comes to healthcare, the most obvious and lasting change may be the shift toward online patient consultations. In the right circumstances, they provide clear benefits to both doctor and patient. They work well for discussion based consultations and for triage. And there can be clear time benefits too. For the patient, a 10 minute visit to a doctor in hospital might represent around three hours away from work. A 10 minute online session on the other hand will take them just over 10 minutes. And for the doctor? If it normally takes an average of one minute for your patient to gather their things, walk to your room then get seated and you’re working on 10-minute appointments. well that represents 10% of the allotted time.

The rise of the video conference

Video conferencing is also now being used for a growing percentage of the other meetings that doctors are involved in. There are progress meetings between trainees and educational supervisors. There are team meetings to maintain and develop everyday working standards. Then there are inter-team project and programme meetings to create new systems and services. Many of these are now taking place online, just as they are in every other sector.

A quick search of the internet reveals all sorts of hilarious video conferencing disasters. You’ll find the toddler marching into the room followed by baby sister then the panicking mother while Dad is being interview on BBC News. There’s the guy who is presentably dressed in jacket and tie – not realising that everyone can see that from the waste down he’s only wearing boxer shorts. And then (oh, dear), there’s the woman who actually goes to the bathroom and everyone can see what she’s doing. Such embarrassing escapades are easily avoidable by engaging even the smallest bit of thinking.

But how do you really get the best out of video conference meetings? It’s useful to consider this from two points:

  • How does this differ from the traditional meeting?
  • How is it the same as the traditional meeting?

So what’s different?

The obvious point is that you’re not in the same room together. So the focus of your attention and the distractions are different. Background noise can be significantly reduced if everyone turns their microphone off unless speaking or directly involved in a discussion. Engagement is always best when everyone has their camera turned on. At very least, it discourages “doing other things” as others can see you.

Most digital conference platforms give you a choice in what you see on your screen. For example, in Zoom, selecting “Speaker view” fills your screen with the person who is speaking. This is a good choice when there is one person talking as you can give them your full attention – just as you would in a normal meeting. “Gallery view”, on the other hand, shows everyone present on screen at the same time. It’s a good choice for dynamic conversation or for the times when you are the key speaker as it helps you’re awareness of the whole group. Controlling and altering the type of view at different times is a good way to keep your focus.

Eye contact is another simple change that can have a significant impact. When we are with people, we spend most time looking at their eyes and mouth. It let’s them know you are interested in them. When you are on a video call you are looking at a screen and the position of your camera will often mean it looks like your gaze is elsewhere. So, make sure you know where your camera is – and look directly into it when you are speaking. It will look like you are looking straight at your listeners.

And what’s the same?

Perhaps the biggest improvements come from recognising there are more similarities to meeting together in one room than there are differences. Acting the way that you would – or at least should – if you were there in person provides good guidance. But that brings up a whole new set of issues because too many “real” meetings are ineffective because the people participating get it wrong too often.

So any meeting, wherever it takes place, will have a better chance of success if:

  • everyone is clear on it’s aim – why is it happening and what should be different as a result
  • everyone has prepared properly – arriving on time with the information they need to hand and with all actions required completed
  • everyone participates in a constructive manner and gives the meeting their full attention
  • everyone is clear and in agreement about what should happen next – who should do what and by when
  • for repeating meetings, the participants regulalry discuss how they are being conducted – what’s going well, what’s not and how they can make things more effective.

If you’re taking part in a video conference meeting from home just do the same things. All you need to add to that list is letting your family members know what you’re doing, go to the toilet before you start and, of course, remember to put on your pants!

Find out about courses running in our Virtual Training Room.

Stephen McGuire – Managing Director

Adapting to the new reality

Sunrise over water

Change is a journey. And, just like any physical journey, it doesn’t happen in an instant. Such a feat transportation is for the realms of science fiction. We don’t just teleport from A to B in a flash – and we don’t expect that to be possible anytime in the near future. A lot can happen on the way from A to B. And the longer the distance, the more unpredictable our journeys become – especially if we are heading somewhere we’ve never been before. So, we shouldn’t expect to be able to instantly change the way that we think, feel and act to be able to function in this new unpredicted reality any more that we would expect to teleport from A to B. Likewise, we shouldn’t expect our teams and colleagues to perform feats of instant change that belong to the world of science fiction either.

Enabling change

Achieving and sustaining real change depends on alignment of numerous behaviours and factors. It demands collaborative and compassionate leadership: envisioning the future; getting others on board; harnessing energy and channeling it in a constructive direction. It requires considered practical management to clarify plans, define processes, allocate actions and ensure everything is on track. Effective team communication where everyone takes responsibility, encourages or challenges colleagues as required and speaks up when something isn’t right is also essential. And it typically requires teaching new systems and skills. Or it may require coaching and mentoring individuals to help them find their own solutions, enabling them to think for themselves.

This doesn’t all just happen by chance. Any collective of individuals will only function in this way if they have developed relevant leadership, management, communication and teaching skills. And this takes deliberate, dedicated effort. But how can you spend time on personal development when there is so much going on? How can you access quality learning activities when there’s restriction on people getting together?

The skills development challenge

At Oxford Medical, we’ve been considering these questions too. We support the development of around 3,500 doctors each year, with the largest percentage of this taking place via courses at locations across the UK.

We’re pleased to be able to say we’ve created a range of CPD accredited interactive online courses over the past few years which have been very well received. Are they better or worse than attending courses? Well it’s better to think in terms of each modality being different. Each has it’s advantages and limitations. So, they’re different entities which each provide opportunity.

Well designed modular online courses mean you can dip in and out as you choose. You can do a 10 minute module any time you have a break. You can chew over the various reflective exercises for as long as you want – 5 minutes or 5 days. Alternatively, you can sit down and work through the entire course in one sitting in the comfort of your own home during an evening when there’s nothing worth watching on TV. It’s all under your own control.

What about courses to attend?

Our courses where you attend in person are available to book for dates where we believe we will be able to safely resume such activities. We’re keeping up to date with latest guidance and making adjustments accordingly. When we had to cancel courses across March and April we were able to successfully support delegates via virtual events.

On virtual events, we explore the same subject matter as the courses where everyone is in the same room. We just do it in a different way. It’s still interactive and everyone still gets the same CPD certificate for attending a 1 day or 2 day course as appropriate. In fact, with a great deal activity moving on to Skype, Zoom and other virtual meeting software, virtual versions of our Consultant Interview or Advanced Teach the Teacher: Mentoring Skills for Doctors provided experience in the perfect format.

So there are always options. They’re all just different. What is important is that skills development continues. In fact, you could argue it’s more important now than ever.

How are you developing and enhancing your skills to play an active part in adapting to the new reality?

Stephen McGuire – Managing Director

In denial of wilful blindness?

Hear no evil, see no evil, speak no evil

“There are none so blind as those who will not see. The most deluded people are those who choose to ignore what they already know.” These words of wisdom still resonate today – some 500 years after they were written by John Heywood. And there’s plenty of evidence that “those who will not see and choose to ignore what they already know” exist within the medical profession.

Take, for example, the report from the independent inquiry into the case of Dr Ian Paterson. He’s the breast surgeon whose unnecessary, inappropriate and ineffective operations on hundreds of women led to a criminal conviction. His 20 year prison sentence makes clear that he holds the ultimate responsibility for his unacceptable actions.

What’s that got to do with anyone else?

Bishop Graham James, who chaired the inquiry, doesn’t hold back in his report. He makes it perfectly clear that the scandal was far more than the reckless actions of a rogue surgeon. “The suffering described; the callousness; the wickedness; the failures on the part of individuals and institutions as well as Paterson himself – these are vividly described in what patients told us.”

The normal reaction to a scandal is to look at the organisational and legislative steps which should be set in place to avoid repetition of similar events. That should sort it, shouldn’t it? After all, Paterson was suspended in 2011. Surely things have tightened up a good bit since then? Well, Bishop James also states, “It is wishful thinking that this could not happen again… Our healthcare system does not lack regulation or regulators. This report is primarily about poor behaviour and a culture of avoidance and denial.”

An “offloading of responsibility at every level” enabled his actions. “This capacity for wilful blindness is illustrated by the way in which Paterson’s behaviour and aberrant clinical practice was excused… Many simply avoided or worked round him. Some could have known, while others should have know, and a few must have known.”

What’s this got to do with “normal” practice?

Paterson is an extreme case. No amount of legislation or policing will ever eliminate the chances of the occasional maverick slipping through the net. But as suggested earlier, there are numerous examples of “those who will not see and choose to ignore what they already know” in everyday medical practice.

Our previous blog posts have referred to the common problematic sub-cultures which have been identified by the General Medical Council. There are sub-cultures centred around divas and factions. There are groups of people where deference to specific individuals creates sub-cultures with patronage at their heart. Groups of embattled doctors are not uncommon. And then there are others who have separated from the mainstream and become isolated.

Just like the doctors who were working with Paterson, who was “hiding in plain sight,” it’s all too easy to develop wilful blindness to the existence of these sub-cultures or to their consequences. Their presence is disruptive to patient care and detrimental to staff well-being alike. Let’s add bullying, rudeness and carelessness to the mix.

Someone else’s problem?

If problematic behaviours are being noticed, rather than denied, then surely someone should say something? Definitely. But who? Could there be an element of wilful blindness to the fact that no-one is taking any effective action? That such lack of action actually sends the message to the perpetrators that says, “It’s ok, carry on with what you are doing.“? To think anything else would, in itself, be an act of denial.

Speaking up and saying, “That’s unacceptable,” can be an uncomfortable experience. It’s bad enough when dealing with a more junior colleague. Maybe worse when it’s a peer. And what about if it is a more senior doctor who is behaving inappropriately? There’s no doubt that these are tough conversations. But change won’t happen without them.

Doctors already dedicate themselves to learning how to have tough conversations with patients. This includes dealing with sensitive subjects, breaking bad news and saying no. How much time is spent developing ability to have tough conversations with colleagues? If improvements to patient care and staff well-being are the obvious outcomes then there has to be a professional duty for this.

How ready are you to have the tough conversations that will make a difference?

Stephen McGuire – Managing Director

Like deja-vu all over again!

Punxsutawney Phil

February 2nd is Groundhog Day. Have you watched the classic comedy from 1993? If so, you’ll remember the cynical, sarcastic news reporter Phil Connors being dispatched to Punxsutawney, Pennsylvania. Once there, he scoffs at the pointlessness of the smalltown annual festival where the happy locals use a groundhog to predict the weather for the next six weeks. Phil hates everything about it. Unfortunately, his day gets worse when he is trapped in the town by an unexpected blizzard. He then wakes next morning to discover he is now (inexplicably) locked in a time loop. Every day, from this day forward, is exactly the same for Phil Connors.

Groundhog day in the NHS

The film was a big hit. So much so, that we now say, “It’s Groundhog Day again!” when the same situation repeats itself over and over again.

I regularly hear doctors on our courses using the phrase in relation to numerous aspects of their working life. Take your pick from the following: disorganisation; wasted resources; bad behaviour of colleagues; the struggle with difficult patient behaviour; the need to prepare for another appraisal. Or how about finding yourself teaching the same thing in the same way to another group of uninspired doctors for the countless time. You may well want to add your personal gripe to that list.

I remember being amused when one doctor introduced a bit of variation to the “Groundhog Day” phrase by saying, “It’s like deja-vu all over again.” (I’m not convinced that he said it as a joke!)

Sadly, many who find themselves trapped in the seemingly hopeless loop struggle to see any humour in their situation. When this is the case, they risk becoming cold, hard, cynical and/or sarcastic. Just like Phil Collins at the start of the movie.

Breaking the loop

However, the original Groundhog Day celebrations have absolutely nothing to do with hopeless repetition. It’s roots are in ancient European traditions which are celebrations of awakening. The appearance of the Punxsutawney Phil means the end of hibernation. It’s the earliest indication that spring is approaching. And spring is nature’s time for new beginnings and fresh starts.

In the movie, Phil Connors initially indulges in some of the very worst aspects of human behaviour. If anything, he becomes even more bitter than before. Then he slowly begins to do some little things that make a difference. As he starts to look at his world differently he dedicates time and effort to improving his abilities. His new skills enable him to bring about some dramatic changes to the world around him. He finds himself contributing more than he ever thought possible – and he’s much happier for it. So are those who are around him.

What efforts are you making to develop the skills that will enable you to break out of your own version of Groundhog Day?

Stephen McGuire – Managing Director

Rumination, automation or facilitation?

How do you really feel about reflective writing? It’s frequently demanded and is an expectation of being a good doctor. You know: “You have now completed this course. Please complete your Reflective Learning Statement.” And you have to keep your e-portfolio up to date for your appraisal or ARCP meeting. Many doctors report feelings of irritation. “Here we go again.” “What’s the point?” “I could be doing something useful instead.” Such thoughts often lead to procrastination. But you know that you still have to do it eventually.


There are a lot of things in life that we do on auto-pilot. It happens when we’ve completed a task over and over again without negative consequence. So, we default to ingrained, habitual behaviour. We do it quickly and efficiently without really thinking about it.

This is a common approach to reflective writing. It’s the chore that has to be done. Going through the motions. Ticking the box. If this is the case, then it genuinely has become a time-wasting activity. If there’s no benefit then what really is the point? You would definitely be better off doing something else. But what’s the alternative?


Things can and do go wrong. Sometimes we say the wrong thing in the wrong way at the wrong time. Sometimes, no-one has done anything wrong – yet we are still exposed to events and circumstances which are upsetting or confusing.

It’s easy to fall into rumination, where repetitive thoughts go round and round in circles. We can become victims of our own thinking. Problematic ideas undergo fermentation. This can lead to pre-occupation and to poisonous fixation. Anxiety, depression and burnout are all-too-familiar results of un-managed rumination. So, we need an alternative to that too.


“Keep a lid on it.” “Dissociate yourself from the situation. Concentrate on the task.” “Move on, there’s another patient here to be cared for.” “Keep your work at work and your private life private.”

On a personal level, tucking our toughest experiences away in our darkest corners can seem like a logical, attractive solution. But what to do when thoughts start to resurface? Drown them out with some form of distraction? This can lead to problematic ‘coping’ mechanisms and even fragmentation of character.

And what about the impact on others? Does ablation of our memories and experiences go hand in hand with abdication of responsibility over our behaviour and actions? If so, then does this lead to constriction of self-awareness? Does it close the door on learning, meaning there is stagnation rather than progress? This is one clear reason for empathy to measurably decrease over the course of a doctor’s training. So this doesn’t seem like the right way forward either.


What’s really required is a method which enables facilitation of strong foundations for stability and growth. Different people prefer to do this in different ways. Silent introspection, discussion with a mentor or reflective writing are good examples of this. When done well, they utilise awareness of the past to inform a better future. But none of these methods should be taken for granted.

Silent introspection can work well for those who have learned and practised a disciplined approach. Otherwise rumination and lack of conclusion may be just a small step away.

Discussions with an experienced coach, mentor or colleagues offer the benefits of externalising thoughts. When we do this, we are more likely to channel our mental processes into something constructive.

The same can be said of reflective writing when it is conducted for the right reasons and using effective methods.

Unfortunately, many doctors have never been taught how to do this well. The ability has been taken for granted. Or if they have learned in the past, they have fallen out of love with the practice through over-familiarity. That’s why we’ve now launched our new course Reflective Writing Skills for Appraisal & CPD.

So, rumination, automation, dislocation or facilitation. What’s your current approach to reflective practice?

Stephen McGuire – Managing Director

Civility matters – all year round

Bad behaviour

“Well that’s just brilliant, isn’t it!” “Here we go again!” “How rude!” “How offensive!” “Look what you made me do!” “Who do you think you are?!?” “Are you trying to make it impossible for us?!?” “It’s not me, it’s you!” “What the #@$%!!!” CRASH! BANG! Thump! “………………….. (silence without eye contact).”

The stakes are high in healthcare. High demands equate to high pressure. Things can and do go wrong. Stress is rife. So, it seems inevitable that tempers get frayed and cross words exchanged. But at what cost?

Our festive season is traditionally a time for reflection, peace and making commitments to move on from the past. But civility matters all year round. Rudeness can have serious consequences. Watch Chris Turner’s powerful 15 minute presentation on the matter. It should make us all stop and think.

To say we must all take responsibility for our own behaviour is an obvious point. At the same time, it’s essential to call out bad behaviour of others when we see it or experience it for ourselves. This latter point is often the most difficult part. Every doctor must ensure they have the ability to have tough discussions with colleagues in an appropriate and constructive manner.

We wish you a happy, peaceful time over the festive season and the strength to spread civility all year round.

Stephen McGuire and all the team from Oxford Medical Training

What’s the opposite of giving feedback?

I’m regularly both surprised and delighted by delegates on our courses. Occasionally, someone says or does something which stops me in my tracks – in a good way. An excellent example of this happened to me just recently.

Dr K was one of 16 delegates on a 2-day Teach the Teacher Course that I was leading. Around half-way through the second day, my impression was that he was quietly paying attention. However, it wasn’t easy to gauge what he was learning at this stage. He was happily participating in small group activities. But he preferred doing this with doctors that he knew well and he rarely contributed to discussions in the larger group. That’s ok. After all, we all have our preferences when it comes to learning. As a tutor, though, you always like evidence that your event is having a positive impact.

An important feature of our course structure is that each doctor has the opportunity to design and deliver a teaching session to their fellow delegates. Taking the role of teacher allows them to experiment, put teaching theory into practice and test out new ideas. The other delegates take on the role of learners for these sessions. This gives them the opportunity to experience different teaching styles and then practice giving feedback. Such sessions are always most effective when the doctors combine their personal ideas and creativity with the concepts explored during the course.

A killer question

When it came to Dr K’s turn, his subject was, “The role of feedback in learning.” We always emphasise that giving feedback is an essential skill for teachers to possess. It’s also vital for strong leadership, management and team communication. (For clarity, we are talking about face-to-face verbal feedback, rather than annual, anonymous digital messages). It’s easy to state the obvious with many topics. The real challenge is often bringing this idea to life. How do you take a well worn message, make people really think and make it hit home with relevance?

So, Dr K began with a simple question. “What is feedback? Can you give me a definition?” Delegates thought for a moment and offered their ideas. “Constructive criticism.” “Pointing out errors.” “Recognising what’s gone well.” “Raising awareness.” “Sharing your observations.” He then offered a dictionary definition. It was a reasonable, but unremarkable start. It was the follow up question that stopped everyone in their tracks.

“What’s the opposite of giving feedback?”

Reverse provocation

This curious question is an excellent example of “reverse provocation”. That’s where you approach something from a diametrically opposite stance from the norm. We often visit this idea during our Essentials of Medical Leadership and Management Course as a method to stimulate creative thinking. Consider the question “How can we get more of our patients to turn up on time for their appointments?” It’s probably been discussed so often that any improvement can seem hopeless. We’ve run dry when it comes to new ideas. So, what about reversing it? “How could we ensure that patients always turn up late for their appointments?” This pushes us to think from a fresh perspective. Creating a list of answers starts to generate the solutions. At the same time, it also helps to reinforce the importance of some points.

So, what is the opposite of giving feedback?

Well, I’m not sure I have one clear, simple answer to this question. Delegates on the course thought long and hard, then offered a few suggestions: “Silence.” “Holding back.” “Acceptance.” “Avoidance.” “Apathy.” “Reinforcement of unconscious incompetence.” Maybe the most insightful response was,”What I usually do!”

In many ways, the answer is less important than the thinking which the question generates. Ultimately, it leads us to think about why giving feedback is so important and why it’s essential that a great teacher can do it well.

So how would you describe the opposite of giving feedback? What are you doing to improve your skills?

Stephen McGuire – Managing Director

Want to start an epidemic?

It would seem reasonable to think that being responsible for starting an epidemic would be the last thing any doctor would want. We usually consider epidemics in the physical sense. But we also see behavioural epidemics infecting a population. The recent escalation of parents not ensuring their kids are vaccinated is a good example. And we typically think of epidemics in the negative sense. We flip this idea round during our Essentials of Medical Leadership and Management Courses. Being responsible for spreading positive behaviour, ensuring improved working practices take a grip across your team and then beyond is a wonderful thing.

We often know what we want to achieve when it comes to leading quality improvement, championing new techniques or transforming attitudes. But how often do initial changes in team behaviour really stick. How often do initially well received ideas slowly evaporate and fail to take a grip? This happens for a broad range of reasons.

The tipping point

Malcolm Gladwell came to prominence through his book Tipping Point: How Little Things Can Make a Big Difference.  He begins by exploring the factors which contribute to a major outbreak of infectious disease.  He then goes on to look at historical events, cultural phenomena and human behavioural trends. His focus is on how things spread through human populations. Along the way, he aims to identify the key factors which contribute towards the reaching a ‘tipping point’. That’s the point when something moves from being small and contained to a few, to become an outbreak which impacts on the many.  These key forces can be applied to the deliberate spread of ideas and behaviours. They can be utilised to start a positive epidemic.

Gladwell proposed that reaching a tipping point requires three active agents:

  • The right people
  • A fertile context and
  • ‘Stickiness’

The right people

Leadership is often a ‘team sport’. We rarely achieve sustained behavioural change with a group of people on our own via one single act of influence. Change requires maintaining contact with our team members. Shift patterns, busy workloads and people working in different locations are just a few factors which make this challenging. So it helps to involve colleagues who are natural connectors, who are good at networking with people. It’s also useful to involve people with credible expertise who have the ability to distill any complexity or confusion into simple concepts. And support from people who can ‘sell’ an idea, who make it directly relevant to individuals will help ensure that everyone is onboard.

Fertile context

Epidemics require the correct ‘breeding ground’.  An infective agent may have a major impact in one situation.  Yet transferring the same agent to a different time, place or culture may mean that it has no impact at all. Timing is essential. People need to be ready for change. This might mean taking an opportunity as it arises, waiting for the right time or taking steps to ensure your team are going to be receptive to your initiative. As well as there being a ‘right time’ there’s also usually a ‘right place’. These two elements can be guided by understanding the prevailing culture which also informs what is expected, respected and accepted.


You have to genuinely engage people if you want them to follow your ideas. You need them to pay attention to receive your message clearly and unambiguously. So the way that you communicate is important. It needs to be personally relevant to people for them to commit. This works best when they understand ‘why’ and “what’s in it for me or the things I care about” is apparent. But one single instance of relevant engagement rarely has a lasting impact. So follow-up is an essential element of making your message or need for change sticky.

What do you want to change and how will you start your epidemic to make sure your ideas spread?

Stephen McGuire – Managing Director