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Its now 69 years since the first NHS hospital was opened on 5th July 1948.

How well do you know this Great British lady?

The NHS is huge and complex. The numerous organisations which form its constituent parts continually evolve, divide, grow and merge. Processes, authority and responsibilities forever shift with each change of the political winds. How can any single person ever expect to exert a worthwhile degree of influence, even if they wanted to?

Ultimately, every clinician wants to provide the highest quality of patient care and to practice to the very best of their abilities. Patient care, however, never happens in isolation. Each moment that a doctor is engaged with their patient is enabled – or in some cases hindered – by numerous systems: regulation, financing, resourcing, quality control to name but a few.

In the foreword of NHS England’s 2014 booklet ‘Understanding the New NHS’, Professor Sir Bruce Keogh, current National Medical Director, eloquently communicates both the importance of and the key first step for doctors to play an active part in challenging and engaging to shape the future. From an early position where he felt that “management” was someone else’s responsibility, Sir Bruce eventually realised, “If I really cared about how well patients were treated then I had a moral and professional responsibility to understand the system in which I practised.” He emphasises that “Young, enthusiastic clinicians can add significant insight into our biggest healthcare challenges, but unless you know how to channel this enthusiasm and how the system works, nothing will happen.” He ends by encouraging doctors “to empower yourself and your colleagues to get to know how the NHS works and really make it your own.”

Though Sir Bruce was speaking to doctors and representing NHS England when he made these statements, his words have relevance to clinicians of every discipline in all four corners of the UK – and indeed beyond.

Ideally, everyone shares this “moral and professional responsibility”. Senior doctors and leaders should bear these words in mind when considering the development of their junior colleagues. At Oxford Medical Training we emphasise the need to see beyond scientific, technical and clinical expertise – the need to support development in all aspects of practice. This is a regular topic of discussion during our various Teach the Teacher, Communication, Medical Leadership and Management Courses.

Understanding who’s who; who does what, where, how, when and why takes both time and deliberate effort. The encouraging support of a senior colleague who is skilled at passing on knowledge and enthusiasm is invaluable. It can be a vital enabler for clinicians playing their essential part in shaping the future of the NHS. You may or may not be or have access to such a person. Could you fulfil this role for others in the future?

Happy Birthday NHS

The words in the section above are the opening paragraphs from our book Everyday Medical Leadership and the NHS which is available as immediate pdf download or as printed copy by post. In the book we will explore the history, structures and finance of the NHS. We will consider the key drivers of organisational change, the conflicting challenges facing the NHS and the different approaches being taken by each of the four home nations of the UK. We will continually relate the ‘big’ topics to everyday leadership for doctors and clinicians of all disciplines.

We also use this book to support learning at the following courses, which are an opportunity to further develop your ideas and understanding via interaction with your peers:

• Everyday Medical Leadership & The NHS – a one day course
• 3 Day Leadership & Management Course for Doctors – where the third day is dedicated to the subject matter of this book.

Why not get to know your NHS including its triumphs, its flaws  and its challenges in more depth?

Stephen McGuire – Head of Development

Ten days after the shocking Grenfell Tower fire the BMJ of 24th June 2017 responded by dedicating seven of its pages to the events. Some readers may have been surprised by the political tone of comments and opinions expressed. What particularly caught my eye, however, was the short column by Helgi Johannsson on page 506. Dr Johannsson is a consultant anaesthetist and clinical director who described his involvement in a third major incident in just ten weeks.

“I am much more emotionally affected now than I was on the day. Some would say we must remain emotionally detached and equate that with professionalism, but I am human.” He goes on. “I feel I am a better doctor for giving myself permission to stop, reflect on what has happened, and to grieve.“

Dr Johannsson’s comments differ from the detached approach taken by many doctors across the globe. Detachment has been promoted as the norm for generations. Advocates advise separation to ensure optimal technical performance and as a self-protection mechanism. This sounds straightforward but does could it be an overly simplistic approach? Is it good practice or just behaviour which persists because of prevalent culture and the way things have always been?

Who benefits from detachment?

The suggestion is that a doctor who is detached will deliver better patient care. Put simply, emotionally disconnection aids a steady mind and a steady hand. Some argue emotional distance as a self-preservation technique. Blocking out the harsh realities of human suffering protects the doctor psychological harm. Others are willing to admit that emotional distance may not have been a conscious choice. They have just gradually de-sensitised. The physical parallel is the natural process of skin thickening in response to persistent irritation.

Let’s pause for a moment though to contemplate the mental well-being of doctors.  Our UK media regularly praises the levels of resilience demonstrated. This is especially true when reporting on the response to major incidents. Such ability to cope is impressive – at least in the short term. But what about the long term?

The effects of over-dependence on ‘experiential avoidance’ as a coping mechanism are well known. They range from poor work-performance through to mental health issues. The high incidence of mental health problems and even suicide for doctors is also well established. It also worth bearing in mind that we are always more open with and believe people that we trust.  We place trust in those we believe understand our personal situation which is dependent on a level of connection. This has particular relevance for interactions with patients and colleagues.

So its worth asking: at what point does ‘professional control’ with a stiff upper lip become an issue? Can it reach the level of professional neglect? The end points are failure to properly connect with patients, colleagues and to protect oneself long term. But if that’s where it ends,  where do the issues start?

Examples of connection

I’ve had the pleasure in recent months of doctors sharing some truly powerful moments of connection during our Advanced Communication Skills courses. For example:

• One doctor bravely shared the moment that their eyes welled-up and overflowed when breaking bad news to her patient’s parents. The case had echoes of the clinician’s personal family experience. Both parents later personally thanked the doctor, recognising they were being supported through difficult choices by someone who really cared.
• A young trainee described the sequence of tragic events her team had faced. She went on to describe how in the following days her Consultant worked with team members to consider their thoughts and feelings. The young doctor eloquently explained the positive consequences of the permission to be open.
• Another delegate raised their personal upset at a lapse in team communication which had potential for dire consequences. Ever since, similar scenarios had become a source of significant anxiety. In response, a senior doctor shared a similar experience – one where the outcome was a patient fatality. He shared what he had learned about himself, how he coped and why he was a better doctor as a result. Their discussions continued throughout the course break-times.

Control versus dissociation

There is a fundamental difference between emotional control and dissociation.  Understanding that difference is essential for quality interaction with both patients and colleagues. Genuine interaction requires appropriate human connection.  Positive human connection depends on empathy.  Empathy requires the application of emotional intelligence. Such application of emotional intelligence in difficult circumstances involves the development of personal resilience.  But its not enough to simply tell someone “be resilient!”  The development of true, long-term resilience is achieved via a set of skills which must be learned. For doctors this learning ideally goes hand in hand with the development of both patient and team communication skills.

• Where do you stand on the ’emotional detachment’ versus ‘permission to grieve’ scale?
• What are the pros and the cons of that approach?

Read the follow up blog posted on 12th December 2017: A prescription for being a better doctor  which offers some thoughts on practical steps related to this issue.

Stephen McGuire – Head of Development

At the NHS Confederation Conference 2017 Jeremy Hunt delivered his first public speech since the general election and his re-appointment as Secretary of State for Health.  In his address he praised the recent heroism of our UK emergency services.  He also stated that he had a great deal of sympathy for ending the long standing 1% annual increase restriction for public service staff.  On the subject of nurses pay he went as far as to promise that the issue “is reflected back to the Chancellor”.

He was effectively sending a very public message to the Philip Hammond, Chancellor of the Exchequer, who is financial controller within the Government: Make the money available for a nurses pay rise.  This strikes a very different tone from the public statements he made before and during the recent junior doctor’s dispute.  This leads to our question:

Has something changed with Mr Hunt?

Quite frankly, a great deal has changed over the past year.

The Health Secretary made direct reference to the manner in which NHS staff responded to recent terrorist attacks and the Grenfell tower disaster.  Such events have focused public opinion.  Social media has, more than ever,  become a forum where the public opinion has the opportunity to develop untethered by the traditional opinion shapers: newspapers, television and radio.  Potential changes to inter-European migration rites due to Brexit have been cited for a dramatic decline in the number of nurses coming to the UK.  Staff shortages are therefore likely to persist and become more apparent at a time when demand on the NHS is growing.  A pay dispute with nurses in such circumstances would be an uncomfortable experience for any Government.

However the recent general election has created a shift in the political power balance of the UK.  A diminished level of control for the Conservative party has led to changed levels of power within the Cabinet of Ministers.

Would Mr Hunt have used a public speech to put pressure on the Chancellor at this time last year?  Some would argue he was lucky to retain his position when Theresa May became Prime Minister.  Some that he was left to sort out his own mess.  Your may have your own opinion regarding his motivations for being seen to put pressure on Mr Hammond .  You may see genuine concern for the plight of nurses and for getting things done.  You may believe that he has learned from the Junior Doctors dispute.  Alternatively you may see opportunistic headline grabbing driven by naked ambition.  Jeremy Hunt for Prime Minister anyone?

What’s this got to do with doctors in everyday practice?

Sit Brice Keogh, the outgoing National Medical Director, has emphasised a doctor’s “moral and professional responsibility to understand the system” in which they practise.  He encourages doctors to “empower yourself and your colleagues to get to know how the NHS works and really make it your own.”

During our course Everyday Medical Leadership & The NHS we explore how to identify the drivers of change.  Its the first step in deciding how to respond.  Whenever we face change we always have a choice in how to react, though sometimes its not obvious.  Such choices are best based on a balance between our level of passion and our belief in our level of control.

“But the NHS is huge” some might say.  “Its the fifth biggest employer in the world.  No single person can make a difference.”

An understandable sentiment.  Yet take a look at the general election result for the constituency of North East Fife.  With a total of 41,822 votes cast the winning candidate won by a margin of just two votes.  So maybe its true that no single person can bring about significant change – but apparently two people can!

Who are you talking to about the changes afoot in the NHS and what you can do in response?

Stephen McGuire – Head of Development

If you are preparing for a medical interview then a recent report on BBC News may have caught your eye. ‘When interviews go wrong‘ is the output of their research into poor and inappropriate interview questions. You might also have taken a few minutes to amuse yourself with Glassdoor’s annual list of tough interview questions.

The sublime and the ridiculous

Such lists make you consider how you would respond to the following:

• If you were on an island and could only bring three things, what would you bring?
• Which magic power would you like to have?
• How many square feet of pizza are eaten in the U.S. each year?

Oddball questions like these will always grab attention. Interviewers using such techniques will no doubt be rather impressed with themselves and claim they are exploring logic, creativity or ability to deal with the unexpected. But what, we wonder, did the interviewer who asked, “How honest are you?” expect to discover? And what criteria did ZocDoc utilise to interpret responses to their question, “What’s your least favourite thing about humanity?”

As a doctor, its probably best to view these examples as light-hearted relief during your interview preparations rather than dwell upon them. Valuable time is better spent concentrating on subjects which your interview panel are far more likely to explore.

So what are interview panels looking for?

Its worth noting that if you have been invited to a Consultant interview then the panel already believe you have the technical skill level required.

To state the obvious, they want to discover as much about you as possible within the time available. They want to know about your experiences and what you have learned from them, your attitudes and opinions, your ambitions. They want to know how you will fit into their team, what you will add and what support you will require to reach your potential.

Some doctors focus a disproportionate amount of time on crash-studying the NHS’s structures and processes. They do this under the false impression that they are about to undergo some form of test of knowledge on the subject. If it were this simple then the panel could save their time by giving the candidates a standard written examination. Developing a thorough understanding of the system is, without doubt, an advantage for your interview – so long as you can demonstrate how you have utilised your knowledge in some manner.

What you should never be asked

UK employment law means that there are a raft of questions which you should never be asked. These include questions of a personal nature with no bearing on your ability to do the job. Examples include opening questions which probe your ethnicity, age, religion, marital status or sexual preferences. These rules have been established in order to protect your rights as an employee.

Unfortunately such questions can occasionally be asked through clumsy attempts to achieve diversity in the workforce, or nervous interviewers trying to find clever ice-breakers. They are rarely asked through genuine prejudice. Should this happen to you, it is entirely appropriate for you to tactfully ask why the question is relevant to the job. Interviewers should always bear in mind that you are assessing their suitability as prospective employers at the same time as they are assessing you.

So lets get back to our initial question….

What’s the worst interview question you could be asked?

Your most effective approach to preparation will always be to concentrate on the most likely topics and questions. You should expect to to face probing questions on a broad spectrum of your competence: how you have developed yourself and others; your planning and organisation experiences; decision making; teamwork and leadership; ethics and probity.

Rather than dwelling on “Who would your three ideal dinner guests be,” examples of genuinely tough questions include:

• Which of your mistakes have you learned most from over the past year?
• Tell us about a time when you felt a patient’s treatment plan was not in their best interests.
• What’s the most awkward subject that a junior colleague has approached you with and what did you do?
• Tell us about a time when you had to ask for help from one of your colleagues.

You may notice that each of these questions has a focus on the facts, your experiences and what you have learned. Responding well to this type of question is how your interview panel will really get to know you.

Imagine they were to ask you, “What’s the worst question we could ask you?”

How could you prepare for that?

Stephen McGuire – Head of Development

What do you think of when you imagine a great teacher?

Is it the commanding, charismatic orator at the front of the lecture hall? The great speaker who can captivate and entertain? How about the approachable figure who easily gets their audience actively involved in open discussion? Or do you think of the innovative maverick who constantly surprises with unexpected methods? These are some of the common responses we receive when asking this question at our Teach the Teacher Course for Doctors.

We all have our individual preferences. Teaching, however, regularly goes well beyond the large group context. The title of this piece is Using great movies to improve medical teaching. So let’s look in that direction for a few minutes.

Let’s consider a different format of teaching.

Where would Luke Skywalker be without Obi-Wan Kenobi or Yoda? Where would Frodo Baggins be without Gandalf, Harry Potter without Dumbledore or King Arthur without Merlin. Where would Daniel Craig’s version of the James Bond character be without Dame Judy Dench’s ‘M’? How about Batman without Albert or even Kung-Fu Panda’s Po without Master Shifu?

Each of these relationships have several common factors. They are all partnerships where one character is supporting the development of another. Each has a learner and a ‘teacher’. Throughout these movies a mutual understanding by both partners continually grows over time. Rather than trying to make replicas of themselves, (as in Dr. Evil’s approach with Mini-Me), the Yoda’s, Gandalf’s and Albert’s take a different approach. These skilled helpers take on the role of mentors.

The mentor aims to support their partner’s growth as an individual, enabling them to face their personal challenges and to fulfill their unique potential. They do so by employing a range of behaviours which regularly go beyond direct instruction. Rather than restricting themselves to the lecture hall, the mentors seek out and make themselves available for one-to-one interaction. They ask probing questions to explore concepts and techniques, promoting both self-awareness and personal responsibility in their student. They also do the reverse. Making themselves open to the pupil’s direct questioning, the mentor’s knowledge and experience becomes an invaluable resource for their apprentice’s self-directed learning. They challenge, commiserate and congratulate. They become a trusted source for the student to share their ideas, frustrations and ambitions along with any feelings which are helping or hindering their development.

Mentors in medical teaching.

Great mentors are more than just experts in their individual specialty. Some experts simply fail to develop the necessary skills for the task. And mentoring should not be restricted to the elderly sage. The mentoring behaviours described earlier can be well utilised by junior doctors to support development of less experienced colleagues. This can be on either a formal, or informal basis.

And a quick point for balance. Other than ‘M’, you may notice a lack of female characters in the list of mentors. Unfortunately , a typical list of great mentors in the movies tends to be predominantly male – unless you want to add Mary Poppins! This is more a reflection on the well-documented lack of quality roles for women in the film industry than it is on real life. We all know numerous highly effective female Consultants, Educational Supervisors, Medical Directors. Its unlikely that they achieve success in supporting the development of others through a one-track, parental Mary Poppins mode.

Expert lecturers will typically have studied their voice projection, body language and presentation structure along with many other skills. They will also have practiced these skills in a safe environment. The genuine skilled-helper, whether working in a formal or informal capacity, will recognise that good mentoring behaviours are the result of dedicated development of the skill-set required. This is the focus of our 1 day course Advanced Teach the Teacher: Mentoring Skills for Doctors.

What steps are you taking to developing your mentoring skills?

By Stephen McGuire – Head of Development

Have you ever attended a communication skills course as part of your training? Did you focus on the methods, tools and techniques to use to improve interactions with patients and colleagues?

This week, I’ve been exploring some training ideas with an associate. Cally Hooks has a great deal of experience in both working as and training others for the role of a standardised patient. We were discussing how that approach is often utilised to assess a doctor’s communication skills. Along the way we got into a question which is rather fundamental.

How possible is it for a doctor to improve communication?

You probably know colleagues who take the approach that you either can or you can’t. They may even point to studies which indicate that doctors trained to use communication tools may even perform less well than their untrained peers. Their conclusion is that “the over-use of tools actually stifles natural interaction”. They may well be correct in making that observation.

Now you may well be thinking, “That’s a surprising thing for someone who spends a lot of time training doctors to use communication tools to say.” So let me explain my approach.

Tools are essential for any profession.

A hammer and chisel enabled Michelangelo to create the statue of David. Yet in the hands of the unskilled they may be able to do little more than knock a hole in the wall.  The master sculptor developed exceptional dexterity through understanding both his tools and the stone which he worked with. In the same way, the expert surgeon understands both tools and anatomy; the expert physician both the medications and physiology. We all want the best quality, most appropriate tools at our disposal. When it comes to communication, the same principle applies. We need the best tools for the job plus an understanding of the individuals we want to interact with. Why they are reacting as they are? Why are they may be struggling to follow recommendations? Why they angry/upset/argumentative, and so on. This applies interactions with patients and colleagues alike.

Some healthcare communication tools appear simple, even basic. The WHO surgical checklist contains several examples of this type. Others, including models for breaking bad news, are more obviously complex.  In the hands of the expert, all can have surprisingly beneficial results.  In the hands of the unskilled, the careless, or those who are using them without awareness of the supporting theory they can be, at best, ineffective or a waste of time. At worst, like any other sharp or powerful tool, they have potential to inflict great harm.

OK, so how do you learn and improve?

Expertise results from dedicated practice and stretching experience. To repeat an Oscar Wilde quote from a previous blog, “Experience is simply the name we give to our mistakes“.

The expert communicators we know were not simply born that way. If you ask them – and they are honest with you – they will be able to tell you of the horrible mistakes they have made in their past. Their expertise has developed through identifying the most appropriate tools for the job and learning how to use them. They may have discovered some techniques by themselves and been introduced to others by colleagues, books, online learning or on courses. Just like Michelangelo, they will have developed more than just knowledge of their tools. They have also developed comprehension of ‘what’ they are working with. In communication this is who, rather than what – team members and their patients.

This is why we concentrate on exploring both tools/techniques of communication and the human condition applied to world of healthcare.

Some of the changes we discuss may appear minor, leading to only small improvements. To quote Tom Peters, author of In Search of Excellence, “There’s no such thing as an insignificant improvement”. The proficiency of that expert communicators we know is the culmination of numerous minor improvements. Their proficiency can only be maintained through regular reflection and adjustment.

Your patients and colleagues want you to be the best you can be.

What steps are you taking to unlock your potential and to improve your communication?

By Stephen McGuire – Head of Development

Imagine you are given a rope attached to a instrument which measures traction. You are asked to pull for all you are worth and your effort is noted. A number of your colleagues now repeat the test, one after another. The assessors then announce that, on average, each member pulled 80 kg. You are now given the opportunity to see what you can achieve when you and your colleagues pull together as a single team of 6 people. The arithmetic is easy. 6 x 80 = 480 kg right? Then some bright spark mentions that TEAM stands for: Together Everyone Achieves More. You start to wonder what the result could really be.

Imagine your surprise when you are told that the team result was just 360 kg. That’s a 25% drop on the sum of your efforts when performing as individuals! You may be even more confused when you discover that some groups undergoing the same experiment displayed far greater reductions in performance.

Can this be true?

Unfortunately, yes. The phenomena was first identified by agricultural engineer Max Ringelmann in the late 19th/early 20th century. He is now recognised as the founder of Social Psychology. His experiment’s results have been repeated throughout the years. In short: average productivity decreases as the number of participants increases.

The most commonly cited cause of the relative under-performance is related to motivation: individual levels of accountability can often be seen to decline as numbers increase. The second key factor is a lack of co-ordination – issues with direction, process, timing etc.

This ‘Ringelmann Effect’ is worth exploring when realising that the modern world of healthcare is driven by a combination of speciality and multi-disciplinary teams. Could it really be that your individual output has declined as your team has grown in size? You may well be thinking, “But I can’t pull any harder!”

High performing teams don’t happen by chance in any arena. This applies to sport, the arts, manufacturing and, of course, healthcare. Teams require dedicated effort, utilisation of a sound knowledge of group development dynamics and quality communication between all participants.  Its not always about pulling harder. Its equally important to be pulling smarter. Pulling at the right time, in the right way, with everyone else.

The results of the Healthy Team Member Self Assessment Questionnaire which participants of our Healthy Teams In Heathcare online course anonymously complete are highlighting where real improvements can be made. We aim to publish our results in a paper later this year.

In the meantime: are you and your teams trying to pull harder, or smarter?

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How much confidence do the public have in the integrity of doctors? What could the impact of recent ‘cheating’ headlines arising from events at Glasgow University be? If you missed the reports, collusion  was uncovered between a handful of students relating to a clinical exam. In response, all 270 final year medical students must now resit the exam. In addition, the accused are facing far more than the wrath of their peers. Disciplinary procedures and fitness to practice investigations are underway.

No doubt there will be considerable review of these events within the academic institutions. Lessons will be learned by medical schools and students alike.

But what, if any, relevance can this have for doctors who sit outwith the formal teaching environment?

Good Medical Practice states the responsibilities of all doctors in relation to the development of others. Here are a couple of reminders:

• 39: You should be prepared to contribute to teaching and training doctors and students.
• 7: You must be competent in all aspects of your work, including management, research and teaching.

‘Assessment’, in all guises, is an essential element of the teaching process. It is therefore a regular focal point during our Teach the Teacher Course for Doctors. Why do we need assessment in the first place? What are the impacts? How to do it well?

• The benefits, when conducted well, include identifying the gaps and focusing attention. There’s also the impact of fostering confidence in the safety to practice and to progress to the next level.  Its worth noting that these apply to both tutor and learner.
• A lack of any assessment can result in misplaced confidence, lack of awareness or lack of direction. Again, these apply to both teacher and student. At worst, misplaced confidence and even avoidance in its many forms can start to grow.
• Problems also arise from poorly set up or poorly conducted assessment: stress; focus on passing ‘the exam’ rather than genuine growth and, yes, even cheating.

Are mutually beneficial assessments possible?

Assessment works best when a trusting relationship exists between teacher and learner. Though both have responsibilities, it is often the teacher who has more impact on shaping the culture. There are many questions to consider, for example:

• Am I assessing facts and theory; application of protocol or dexterity with technique; attitude and behaviour, or some combination of these?
•  Will I focus upon checking capability at one isolated event, by one method? Or are there benefits from a broader approach?
• If the learner can demonstrate performance today, will they be able to achieve the same standard tomorrow? What about  next week and next month?
• How will performance vary in a different environment with a different team, different equipment, different patient – even with a different assessor?
• What are the consequences of the learner falling short and how will I share this information with them?

It is possible to informally assess on an ad-hoc basis. The best teachers, however, are considering their approach from the moment they are clarifying their learner’s objectives.

What steps are you taking to ensure productive assessment in your teaching practices?

Mary Berry, the UK’s queen of baking, is back on television. The esteemed presenter has a depth and breadth of knowledge well beyond the majority of our capabilities. We therefore expect that we can and will improve by watching her in action, explaining what she is doing and why.

So do your cakes, buns or pies turn out just like Mary’s?

For most of us, the answer is a disappointing no. Though we may well deliver a reasonable effort, making genuine improvement in the quality of what we produce can be frustratingly elusive. “What’s that got to do with being a doctor?” you may ask. Well we’ll come to that in a moment.

Not long ago TV was full of teaching programmes: how to cook like a master; paint a beautiful picture; how to redecorate your home. In recent years, such programmes have diminished to a trickle. Our viewing choices have switched from direct tuition to watching others taking on challenges: Masterchef; Grand Designs; even The Great Pottery Throw Down! Much of the teaching has moved online. YouTube has multiple teaching sessions on almost any subject you might think of – as well as some that you might not!

Why the change?

Broadcasting is an excellent medium for entertainment or for transferring information. Information includes facts, process or opinion. Great examples from television include News at Ten, Question Time or any documentary involving David Attenborourgh. It is a highly efficient method of ensuring that large numbers of people receive the same message in the same manner. In teaching broadcasting often arises as lecturing, demonstrations and giving opinion to less senior colleagues. These approaches, however, have their limitations.

Pure one-directional broadcasting makes no effort to checking what has been understood, what is believed or what the learner is capable of. For learners, developing ability to utilise information typically requires some form of activity. To this end, television and radio are increasingly striving for interaction with the audience, often via social media. Our own online courses generally focus on introducing theory before encouraging practice or reflection. For example, Teach the Teacher Online guides you to develop a teaching plan of your own. Healthy Teams in Healthcare, another of our online courses, utilises a structured set of questions which guides you to reflect on your interactions with your team members.

The relevance to teaching as a doctor

We regularly meet doctors on our Teach the Teacher Courses who initially struggle to think beyond broadcasting. Their personal recollections of being taught are typically by an all powerful, opinionated lecturer or demonstrator. It is a rewarding moment when they finally experience true engagement with their learners. At this point they discover new ways to assess progress and provide assistance which is personalised. There are benefits for both teacher and student.

So if your cakes aren’t turning out just like Mary Berry’s its likely that need something other than to watching more broadcasts. You will benefit far more from someone watching your technique, discussing it with you, giving you direct coaching or personalised tips. And it doesn’t need to be Mary who does it. Just someone with the skill level required to support your learning.

So can anyone help me with my pancakes please?

A recent column in the BMJ reported Jeremy Hunt expressing his opinion that doctors are unwilling to take on managerial roles. (BMJ2017;356:j529). The Health Secretary indicated that this was a consequence of doctors fearing, “I will not be able to control everything,” and “I sure as hell am going to get the blame if something goes wrong.”

You may, or may not agree with his reasoning for any such unwillingness. As with many healthcare related problems the root causes are likely to be complex and multi-factorial.

Let’s consider the impression that stereotypical medical professionals have of ‘managers’ – be they from clinical or non-clinical backgrounds. There have been numerous initiatives at fostering the belief in ‘one team with common goals’. At one end of the scale are dedicated meetings and team building activities. At the other are simple calls to abandon the old jokes of ‘the dark side’. The latter is a recognition that negative perceptions can easily be unintentionally reinforced in subtle ways. Its admirable that the BMJ has dedicated many pages over the years to explore the issues and the solutions.

Take a moment, however, to look at the image that was chosen to accompany the report in the BMJ.

What does the image of the man in the red suit walking in the opposite direction suggest about the choice a doctor faces when considering involvement in management?

Is it that taking such a step means somehow going in the ‘wrong direction’? Is undertaking a management role seen as giving up on patient care, something less human, even making a decision to no longer be a ‘real’ doctor? Come to think of it, what is a ‘real’ doctor? As mentioned, the negative perceptions can easily be unintentionally reinforced in subtle ways.

The are many types of doctor, all acting in the best interests of their patients. One description of what they tend to have in common could be: they strive to establish what is going on and why; consider the likely implications and outcomes; develop logical intervention options and initiatives; identify and implement the best course of action under the circumstances. That same description could actually apply to virtually any managerial role. The thinking of Evidence Based Medicine has clear parallels to the approaches of Evidence Based Leadership & Management.

What matters most – the title you have or the work that you do?

Regardless of titles, we all lead and manage. Leadership and management are, first and foremost, behaviours. We get things done through our interactions with others. We get things done through the utilisation of systems processes and resources. Whether you have a leadership or management title or not, development of these skills throughout your career will increase your influence and impact with clear benefits for your organisation, your colleagues, your patients and, of course for yourself.

What would a positive view of a doctor choosing to take on a formal management role be? That you can have a greater influence in the way things are done? That you can influence the practice of a greater number of doctors? That you can influence the care and outcomes of a greater number of patients?Is that something that a doctor should drift into as they wind down in the late years of their career? Or something to be grasped with ambition?

Its easy to reinforce the negatives views.

What can you do that would reinforce the positive impressions of leadership and management roles?