Doctors in Training – Anger and Frustration

Well that’s a headline in the General Medical Council’s 2016 annual report on the state of medical education and practice in the UK that was published at the end of October 2016.

That’s an unusually strong observation from the GMC.

Here’s the text under that headline:

This year there has also been the added dimension of industrial action. The anger and frustration evident in the dispute between the Junior Doctors Committee of the BMA and the NHS in England suggest levels of alienation that should cause everyone to pause and reflect. This is not just about terms and conditions or levels of pay. It is generally acknowledged that there are a host of underlying non-contractual issues, some of them long standing, that have helped to create this dangerous level of alienation among the next generation of medical leaders. This should worry not just those of us close to the medical profession, but everyone concerned with the future of our healthcare system.

Hello, and a very warm welcome to this introductory episode of the brand new Step Up To Medical Leadership Podcast.

Let me outline what this weekly podcast is all about and why you might like to be involved, either subscribing to future episodes or perhaps taking part yourself to share your perspective on supporting junior doctors in their preparation for medical leadership.

I’ll invite you to join our online discussion to help us make this podcast as valuable as possible. You’ll find the discussion in social media using the hashtag #sutml for Step Up to Medical Leadership, and on our forum at

Our goal in the podcast is to encourage junior doctors to step up to medical leadership earlier in their training career, more frequently and with greater impact.

I’m Peter Button and for more than 15 years now, I’ve coached Specialty Registrars as they approach their panel interview where they hope to be appointed as a consultant.

My role has been to help them to prepare more effectively and as a consequence, to win their chosen appointment. I’ve helped them to improve the content and presentation of their CV, to write better online applications, to have better meetings with potential colleagues in pre-interview visits and to practise their presentation and interview skills.

In preparation for their interview, we’ve looked together at the range of current issues with which they need to be familiar. I’ve helped candidates to develop their awareness of the implications of the Francis Report, the five-year forward view and sustainability and transformation plans.

I’ve helped these doctors as they prepare to make the highly significant transition from junior doctor to consultant.

Over that time, I’ve learned that one of the most consistent elements of feedback from interview panels is that candidates fail to sell themselves effectively.

I’ve also seen the emergence of medical leadership as a huge challenge and opportunity for junior doctors. The evidence is clear and compelling. Healthcare is better when doctors are in significant leadership roles. However, junior doctors receive little training as medical leaders. So often, I’ve seen Specialty Registrar CVs where management and leadership experience is limited to having done the rota and attended a couple of courses.

Two clear conclusions have therefore emerged:

1. Junior doctors need to learn how to sell themselves more effectively, especially if they’re seeking particularly desirable roles in specialties with significant competition from strong candidates.
2. Medical leadership is typically hugely under-developed in training for the large majority of trainees.

The episodes of this podcast are therefore going to be all about how junior doctors can step up to medical leadership earlier in their training careers, more frequently and with greater impact.

And my perspective on this issue is not that the doctors should do this because it’s self-evidently a good thing, but so that these doctors can sell themselves more effectively because they develop genuine medical leadership competence and experience. And they have much better stories to tell in their consultant interview.

Instead of referencing a management training course that they’ve attended, they’ll speak with evident confidence about the range of genuinely valuable initiatives that they have led. And they will speak from their authentic experience of having already stepped up to genuine medical leadership.

And as a consequence they will sell themselves more effectively and make it more likely that they will win their chosen consultant appointment.

I’m not a doctor. For over 30 years now, my day job has been to train business development and sales teams and their leaders. I’ve helped my clients to improve their systems, processes and skills to win and retain more new customers and clients.

Way back, towards the end of the last century, I had this call out of the blue. “Hello Peter, my name’s Martin Clark and I’m designing a programme to train junior doctors to improve their CVs. I’ve been asking around to find somebody with the experience to help and your name came up.”

Well, I got involved with Martin and his team and I travelled down to Bristol to help the leader of a medical conference to run a CV and interview skills workshop with some ophthalmologist SpRs as they were called at that stage.

And I came across these CVs that were 12 and 15 pages long! All very different to my commercial world. But much more significant was that this was my first experience of training doctors. In my career at that stage, I’d simply not previously had the opportunity to train and coach such good learners.

I was really struck with their deference to authority and their humility.

It was only later that I began to realise that whilst this deference and humility is good, in that it makes them safer doctors, it also has a specific impact in discouraging these juniors to step up to medical leadership.

But overall, I just remember vividly how I felt back then about what a privilege it was to work with these junior doctors.

Since then, I’ve been continually impressed by their sustained application and commitment and the sheer effort that they’ve made to get to this stage of their career. And of course it’s been enormously interesting to have an informed perspective of the huge changes that have been shaping the NHS.

Since that phone call all those years ago, my respect for doctors in training has simply grown and grown.

It’s late October 2016 and we’re starting this Step Up To Medical Leadership Podcast. What are we hoping to achieve?

1. We want to develop a genuinely useful resource for junior doctors who want to step up to medical leadership earlier in their career, more frequently and with greater impact and who need all the support that they can get.
2. My colleagues and I need to develop the very best awareness of this pivotal issue so that we can support the doctors who we are coaching. There is so much that we need to learn ourselves.
3. Of course, it’s our hope that if we develop a genuinely useful resource, the podcast will play a role in raising awareness about what we do.

So what will be the format of future podcast episodes?

Well, we’re not entirely sure! At this stage, we just don’t know exactly what will work!

But we’ve budgeted the resources to produce the podcast weekly. We’ll just get on with it and see what works best!

Until we get into our stride and begin to get more feedback, here’s what we’re planning:

  • We certainly don’t see our role as lecturing people about medical leadership! Yes, we’re passionate advocates but there are many others who are far better qualified to share their experience and wisdom. So primarily, we see our role in the podcast to ask good people some great questions on your behalf. The main podcast content will therefore be interviews with the people who really DO know about medical leadership and how junior doctors can become increasingly involved.
  • And the key interview question that we want to ask again and again will be “what can a junior doctor do TODAY, even at relatively early stages of training, to develop real medical leadership experience?”

We plan to interview a wide range of people to develop the broadest possible spectrum of perspectives and practical ideas. If you know somebody who might like to be involved in this project we’d love to hear from you or them!

How often will we publish podcast episodes? Our plan is to publish a new episode each week within a series structure where each series will focus on a particular aspect of junior doctors stepping up to medical leadership.

And just to re-iterate, our particular perspective is that we’re trying to help junior doctors to develop real medical leadership experience so that they have better stories to tell when they get to their pivotal consultant panel interview. And that when they tell their stories, they have terrific evidence of genuine impact in improved healthcare outcomes.

So, that’s what this podcast is all about.

We want to play our part in developing the vision of junior doctors genuinely getting stuck into medical leadership as a core competence. And critically, that trainees can do so much for themselves to actively seek opportunities to provide authentic medical leadership experience, as opposed to waiting for this training to be given to them. They can be encouraged to lead initiatives, projects and to join the collaborative, shared leadership of teams of colleagues and stakeholders.

And they can play a pivotal role in helping to shape the fundamentally better health and social care framework that must emerge in the coming years. In playing this medical leadership role earlier in their career, they will be better equipped for the fundamentally different role of doctors that can be envisaged in a society where we can safely predict some key changes:

  • They will be many more older people with co-morbidities
  • Everybody will become increasingly adept at equipping themselves with knowledge from Dr Google and consequently their awareness of treatment options will lead to expectations that will be a challenge to manage
  • Pharma will continue to develop an exponentially growing range of products and services and they will continue to develop their ability to shape expectations and demand
  • Wearable technology will provide real-time data that enables a whole range of healthcare provision from people and organisations that will leave doctors role fundamentally changed.
  • And healthcare budgets will inevitably remain limited because tough political decisions will not go away

Whilst there’s always going to be a unique frontline role for doctors, it seems highly likely that increasingly they will be enablers of the processes that deliver better health outcomes.

We are going to need experienced, effective, proven medical leaders as never before!

However, let’s get back to that headline in the GMC’s report: Doctors in training – anger and frustration.

At a time when all of the research and recent reports confirm the correlation between medical leadership and improved healthcare outcomes, we currently have a generation of future medical leaders who are angry and frustrated.

And here’s my concern. I just know that even when junior doctors understand the vision and want to step up to medical leadership, they’re going to face huge hurdles. Some of their senior colleagues will undermine their efforts, perhaps without even knowing that they’re doing it. The need to fill rota gaps will simply take great chunks of trainee’s time.

Leadership is hard!! Medical leadership is uniquely challenging because of the complexity and of course the implications of failure.

So, we’re embarking on this podcast journey to explore the implications of junior doctors stepping up to medical leadership earlier in their training, more frequently and with greater impact.

We’d love to hear your observations about what we’re doing. As I mentioned earlier, we’ve started a public discussion forum and it will be great to have your involvement. You’ll find the forum if you go, that’s H, O, M, E, S, T, R, A, I, T .com. You’ll also find the community link in the navigation on the website. Click on resources and then community.

If you’re active on social media, we’ll also pick up and respond to posts on the major social media platforms if you include the hashtag “sutml” for Step Up To Medical Leadership.

I’m Peter Button and you’ll find me on Twitter, Facebook and LinkedIn. I’ll be really interested to hear from you.

And of course, you can subscribe to this podcast. Just search for Step Up To Medical Leadership on iTunes or wherever you get your podcasts.

You can also sign up to receive highlights from the podcast. We plan to distil the most significant insights into a monthly written update. Go to the podcast page on the homestrait website and leave your email address and we’ll make sure that you receive your copy.

I’m heading up to the Leaders in Healthcare conference in Liverpool in the first week of November and then the following week I’m going to the Kings Fund Annual Conference in London. I’ll speak with a range of delegates about what we’re doing with this podcast and I’m hoping that some of them will be happy to have their observations recorded so that you can hear their views.

If you’ll be at either of these conference and you’re happy to be interviewed for this podcast, it will be great to hear from you!

Our challenge and opportunity is to equip and inspire the next generation of medical leadership. We really need your voice and perspective to help us to shape what we’re doing. It will be great to hear your observations and comments in the community discussion.

Thanks for your interest. I’m really looking forward to what emerges from the conversations and discussions that we’re seeking as we encourage junior doctors to step up to medical leadership.