Mastering Clinical Uncertainty: Why Curiosity is an Integral Skill for Every Doctor

0:04SPEAKER_02:Hello and welcome to Why Medics Matter, a podcast for doctors by Doctors by Doctors Training. We are your hosts. I'm Dr. Amy Burbridge.

0:14SPEAKER_00:And I'm Dr. Salmon Fruza.

0:16SPEAKER_02:And today we are joined by Dr. Jason Hancock. He is a consultant psychiatrist and director of medical education with an interest in uncertainty. Jason, would you like to tell us a little bit more?

0:31SPEAKER_01:Absolutely, yes. Thank you very much for having me here today. It's great to be speaking with you. So as you've said already, I'm a psychiatrist. I'm a director of medical education. I've always had a particular interest in education and how we can support and train our doctors to develop the skills that they require to be excellent doctors. And I think uncertainty, for I guess reasons we'll we'll talk about shortly, is just such an important skill for resident doctors and for all doctors that it's something I've been particularly interested in throughout my training.

1:02SPEAKER_01:And I've been lucky enough to combine a job and a role that allows me to research that and also to research how we can best support our resident doctors to develop more positive responses to uncertainty and also how we can help supervisors to help their resident doctors develop those more positive responses to uncertainty.

1:21SPEAKER_02:I'm going to start with a question. As an acute physician, I deal with uncertainty all day, every day. But what I'm noticing is that why do we even bother with uncertainty? We have so many investigations. We have AI, we have genomic sequencing. Are the answers all there for us? Isn't certainty a thing of the past?

1:48SPEAKER_01:Well, I think um you probably won't be surprised to hear me say, no, I don't think it is a thing of the past. I can start with a definition because I think often when talking about uncertainty, we all kind of know what we mean, but we might not necessarily mean the same thing. So when I'm when I mean uncertainty, I'm I'm using Hillen Atau's definition. I think uncertainty is conscious awareness of a ignorance about a particular aspect of a world, of the world.

2:19SPEAKER_01:So what I mean is like when I'm making a clinical decision about a diagnosis, a treatment, a management plan, I have some awareness that I do not know what the outcome will be for this patient in front of me right now. And that can be caused by several different things. So it might be caused by probability. So I guess in the example you gave there, there might be certain clinical decisions that we make, such as the prescribing of a certain substance, drug, where we have lots of evidence that tells us how likely that is to work, what the risk of side effects might be, what the numbers needed to treat might be for this population, but I still don't know for this individual patient in front of me how likely is this to work for this person right now.

2:57SPEAKER_01:As a psychiatrist, I've become, I guess, particularly interested when thinking about the other causes of uncertainty. So that might be ambiguity or complexity. So for ambiguity, that's where there might be missing or imprecise or conflicting information. So it might be in that situation that you're a resident doctor, it's 4 a.m. You're admitting a patient to the acute medical unit, and you know they have insulin-dependent diabetes, but there might be missing information.

3:21SPEAKER_01:So you might not know what type of insulin that patient usually takes or the dose. There might be imprecise information, patient might have delirium or acute confusion or state, and it's giving you information about that, but you're not sure how accurate that is. Or conflicting information. The patient might say one thing, their the relative might tell you a different thing, their GP record might say something else, but you still need to make a decision at four o'clock in the morning about how to proceed with that patient.

3:44SPEAKER_01:And then complexity, that might be the same scenario, but then you've added another kind of layer of unknowns. So it might be that patient now has sepsis, which has had an unpredictable impact on their insulin tolerance, yet you've still got to make a decision about what to do at 4am. So I hope I, you know, I I don't need to say much more to convince you that uncertainty is integral to our worlds of doctors. And um, you know, we all we all can see that, but I think it's in a world where we have increasing technology and increasing data and evidence, it's really important to think about how what role does uncertainty have and what how should we respond to that as doctors?

4:23SPEAKER_01:That's I think the key kind of question. How can we support our more junior colleagues, our colleagues to develop those more positive responses?

4:31SPEAKER_00:Jason, um, medicine can be an art and a science or are a merger of art and science together. And I remember training with a very famous pediatrician called David Haig, and his wise words would say to me, if nobody come, if nobody comes back, you're admitted too many people. And he taught me to deal with uncertainty, to be comfortable with risk. It feels very different at the minute. Um how do we address this and and why is it different?

5:05SPEAKER_01:So so within your incredibly important questionnaire, there are so many different things we could unpick and start to think about. So from an uncertainty perspective, we know that the way doctors respond to uncertainty will influence how they think, how they feel, how they behave. So a lot of my research has has looked at how how our responses to uncertainty might influence our emotional responses. So am I more likely to develop stress, anxiety if I'm less tolerant of uncertainty?

5:34SPEAKER_01:But as you say, we we also know that those doctors who are less tolerant to uncertainty or have less positive responses are more likely to admit people to hospital, more likely to order excessive investigations. And that comes from a you know a place where actually you use the word risk, we just need to then start un disentangling the difference between risk and uncertainty. So it might be that to effectively manage risk, so I think when we're talking about risk, we're saying, well, how can I how can I do my best to reduce the likelihood of this negative outcome for this person?

6:08SPEAKER_01:So to mitigate risk, I might be in a position where I'm admitting people to hospital or ordering additional investigations. Now I might be effectively mitigating the risk for that particular problem, but in doing so, I'm not necessarily responding to uncertainty positively. And although I might mitigate the risk of a negative outcome for this particular condition, actually I might have negative unintended consequences for the broader patient because admitting people to hospital might be associated with other problems and difficulties over time.

6:34SPEAKER_01:So risk and uncertainty often use interchangeably but are not the same thing. The actual question you asked, which is the I guess million-dollar question, isn't it? How can we therefore support doctors and resident doctors to more effectively sit with uncertainty? And actually, there's quite a lot of evidence now, of which I've I've contributed to to some extent, but there's a lot of research from others to think about how we can better support doctors to sit with uncertainty.

7:01SPEAKER_01:So that might be as you in your role as a supervisor, as a resident doctor yourself, or as an NHS trust. Like I can I can think and talk through that shortly. I guess the final thing I'll just do before thinking about that is I'm trying to use my words very carefully, as you might see, and I'm trying to not say tolerate uncertainty. A lot of the literature talks about should we tolerate uncertainty more. But but I think that's perhaps slightly too simplistic.

7:27SPEAKER_01:And actually, we need to not forget the important role that uncertainty can play for doctors and the situations where it might be a positive thing. So actually, if we have an immediate negative response to uncertainty, that that could be a positive thing in some circumstances. It might actually activate something within us as a resident doctor that says, oh, something's unusual here. I I might need the support of my seniors, or I might just need to pay more attention to the information I'm receiving here.

7:54SPEAKER_01:So I don't think it's just about producing a population of doctors who are more tolerant of uncertainty. I think it's trying to help people sit with uncertainty, perhaps for longer, and to recognise the transient negative emotional experiences when they get them and know what to do with it, really.

8:10SPEAKER_00:Twelve sort of name in it, really, isn't it? You know, and you see some cases where your gut is just telling you this doesn't feel quite right. So it's having that cognitive awareness of I suppose of your ignorance of the outcome in and some more sometimes more cases than others.

8:27SPEAKER_01:Absolutely. I think it's really important to try and support, well, I guess I'm I talk quite resident doctors, but ourselves just to recognise those situations where yeah, we feel that.

8:37SPEAKER_00:And I think if you think about the the all doctors and all practitioners, are tolerant tolerant, as you said, tolerance is the wrong word, but this awareness and dealing with uncertainty changes as you transition to more responsibility. And and and a lot of our training pathways are to get people to that senior position, whether they be SAS or consultant. Um, because there's a huge variation in consultant practice and admission rates and discharge rates.

9:06SPEAKER_01:Absolutely. And medicine is a broad church. I mean, maybe we maybe we don't want a whole population of all doctors and all specialities and all seniorities becoming more tolerant or having much more um, I guess, violax attitudes towards uncertainty. Actually, maybe in certain circumstances we want people to be less tolerant or to have not the same response to uncertainty. I think we need to, yeah, also have an awareness of the the potential benefits and having a range of experiences within our population of doctors.

9:35SPEAKER_02:Can I just um come in here then? And do you think that this is our intolerance of an intolerance of uncertainty starts at medical school? Because I went to medical school quite a long time ago. I I've never even heard uncertainty or tolerance of uncertainty. It wasn't talked about. We weren't taught about clinical reasoning. We weren't talked about how we make decisions. We didn't even know the phrase metacognition. And then you all of a sudden start as a foundation doctor, resident, doctor, and people start to talk about these terms of uncertainty, ambiguity, risk taking.

10:14SPEAKER_02:And it's like, what is this? I've never even heard of this.

10:18SPEAKER_01:It's it's a really important question. And I think, you know, where where where should we be supporting our learners, you know, undergraduate, postgraduate trainees to begin to understand this? And there are two different schools of thought. So some scholars would say, actually, in medical school's too soon, and people can't really engage with this idea and this concept until they are practicing as a professional, practicing kind of autonomously in those early career roles.

10:46SPEAKER_01:Others would say, Oh no, as early as possible, we need to be introducing this at medical school, and we need to be at least introducing the concept. And I think I'm the same as you, I'm not sure I ever really had an awareness of uncertainty at medical school. As a psychiatrist, I've become become more interested in medical and explained symptoms. I didn't know that was a thing at medical school, I didn't know that existed. Um, and I think we are getting better at introducing this concept construct earlier.

11:13SPEAKER_01:So some of our work has looked at problem-based learning, for example, and how you can, as a problem-based learning tutor, role model more positively responses to uncertainty. So I think it's really important that we try to introduce this early, but equally be you know, realistic, be kind on those learners who are very early in their career and you know, struggle certainly more to see uncertainty as something that is integral to medicine and see it more as a kind of internal flaw that they are uncertain, and they make an assumption that that might be more about their lack of knowledge rather than the reality of a lack of broader understanding of knowledge across across medicine.

11:54SPEAKER_01:So I think it does need to start early, but uh again, there's quite a lot of growing evidence as to how you can do that, but you do need to introduce it carefully at medical school, and you need to be mindful of the potential negative consequences of introducing this for a population of learners or medical students and not truly supporting them through that uncomfortable feeling.

12:14SPEAKER_00:So, what for many of our people who may be listening who will be supportant students, resident doctors, um you talked about some evidence base about things you can do. Just from a really practical point of view, how do we discuss this on the ward in our patients? So we start to get what's been your experience and what sort of has has worked?

12:37SPEAKER_01:So that's a really important question, and I'll think I'll talk that through from the then perspective of the I guess award consultant, senior doctor, special energy doctor. Um, what can we do? So the first thing I think we need to do is have an awareness, an awareness of our own responses to uncertainty, also an awareness of the responses of our resident doctors. Before answering your question fully, I think there's one really important concept that we need to have another awareness of, and that's the impact of transitions.

13:09SPEAKER_01:So there's quite a lot of evidence now that as doctors, as learners move to a new role, the process of moving to that new role will have a significant negative impact on their ability to sit with uncertainty. So that might be moving from preclinical to clinical training at medical school. It's definitely moving from final year medical school to foundation training, it's probably moving from foundation training to speciality training, and it's also going from speciality training to becoming a consultant.

13:35SPEAKER_01:We know that those things impact on a person's ability to sit with uncertainty. And as a supervisor or as a doctor on the ward, that's particularly important in those first couple of weeks of a placement. So you need to have less or different expectations of your colleagues and resident doctors in the first two weeks of your placement, their placement compared to later in the placement, because we know transitions are really important. And when you start to have an awareness of that and have reflected on your own responses, the really practical things that people can start doing on the wards will be things like talking aloud in MDTs or in ward rounds, you know, naming it as a senior doctor, trying to demonstrate intellectual candor in those circumstances.

14:18SPEAKER_01:So just being open about, you know, this is how I see this situation, this clinical problem. These are the things I know, these are the things I don't know. This is the plausible best or worst case scenario. But trying to share some of that um, I guess, honesty and vulnerabilities, intellectual candor, balancing the vulnerability with the credibility. So it's not that I don't know what's happening here because I'm an incompetent doctor. It's it is integral to medicine and it is not possible to know what the outcome will be here.

14:47SPEAKER_01:But this is how I see it, and this is how I, as a senior, would start to work through that. Um, and that might be in a very practical way on in MDTs and ward rounds, it might be through supervision. So in psychiatry, you're incredibly fortunate that we have another level of supervision, which is psychiatric supervision, an hour a week, hopefully delivered in a consistent, safe place in a psychologically safe environment, really important to support our resident doctors in that way.

15:12SPEAKER_01:Um, but then also, yeah, transitions incredibly important as well. Having that awareness, I think, as a as a as a senior doctor on a board, really important.

15:22SPEAKER_00:I I must say, I think the biggest transition for a lot of people now is getting their consultant. I think we're very, very good at supporting people, and it might be like stuff which sound quite trivial. You know, you you go to an outpatient setting and you've got to make a decision, this child of headaches, do I scan them or not? You know, the implication of potentially putting somebody for an MRR a year for dealing with that uncertainty and that confidence.

15:51SPEAKER_00:And and I relied a lot on my colleagues, my peers, um, to sort of uh because I and I felt safe in a quite a small team, but I I do worry about some of the bigger teams that emitting vulnerability of you know the the stupid question that you think you should know. Any advice for any if that resonates with anybody, have you got any personal advice for people?

16:14SPEAKER_01:Yeah, that's I mean that's a really great question. And if those of you who who can see the visual, I'm nodding a lot as you're asking those questions. It's um you're absolutely right. I think the step up from a resident doctor to a consultant is incredibly important and is one that has perhaps not been fully appreciated. I think there's a great paper, I think Anna Collini, I think, looked at this in emergency department consultants. Um, and you know, it's a really important construct, and it's important to name it today.

16:43SPEAKER_01:I did, from a personal perspective, exactly the same as you. I was, I guess, in a fortunate position where I moved up from an ST6 to a consultant job in the same team, which had some benefits, lots of disadvantages as well, perhaps. Um, but I had a really good peer network of consultants who I felt able, and you know, they felt psychologically safe for me to be able to say to them, I I don't know how to proceed here, how would you do this? What strategy would you use?

17:12SPEAKER_01:I made a good use of our peer group in doing that. Um, so that was something that was a really useful thing for me. I appreciate other people might not be in such a fortunate position. But actually, your question as well also reminded me of an important thing to be aware of as moving to a consultant role or actually transitioning into any role, is that the evidence also shows us that actually if we want to be in a position to best manage the clinical uncertainty, we need to first try to reduce all of the other unnecessary uncertainty that sits around that.

17:44SPEAKER_01:So we're talking here about clinical uncertainty, but obviously uncertainty exists beyond that. You know, where I'm moving into a new role, where can I park my car? How do I get my lunch? What's my voter going to be? What are my expectations? What is my role? And all of the evidence, particularly the book of Georgia Stevens and Michelle Nazarus in Australia, is kind of saying, well, the more you can do to reduce that unnecessary uncertainty, will support doctors, resident doctors, new consultants to better engage with and sit with the clinical uncertainty.

18:13SPEAKER_01:And that's in my role as a DME. That's one of the things that I think is really important. So as much as we can do to prepare our new doctors to reduce that unnecessary uncertainty puts them in a position to best manage their clinical uncertainty.

18:27SPEAKER_00:And I think that amplifies just as you're talking our international colleagues who are new to NHS. All those elements that a lot of people are doing some good work on.

18:44SPEAKER_01:Absolutely, incredibly important. And yeah, international colleagues, international medical graduates, really important. The 10-point plan as well, that um I'm sure we talked about and talked about in this podcast previously. Um, those are really important things for us to get right. In in part, you know, because that it's just the right thing for us to get that right, but also because actually we know that the educational outcomes will be better as well.

19:07SPEAKER_01:If we can get that right and we can best support our colleagues, they will be able to truly engage with training quicker, which is really important, um, particularly given the complexities of training and the other challenges that those that resident doctors are experiencing. Um, yes, you're right, really, really important.

19:23SPEAKER_00:I'm conscious I've dominated. I've because I'm so passionate about this topic, I'm gonna give Amy a chance. She's got a long list of things that she wants to talk about.

19:32SPEAKER_02:Um, I guess I have got a lot of talk about, I'm aware of the time. Um how we've talked a lot about uncertainty. Can we use simulation to help doctors with uncertainty?

19:52SPEAKER_01:So the short answer is yes. I think there are there are several different ways we can do that. Um actually looking first of all, I'll talk about medical school because there is evidence there around the best use of simulation. So we know that simulation can be used to support people develop better responses to uncentive. The challenge with simulation, particularly at medical school, is that simulated scenarios are often textbook scenarios in which the diagnosis is relatively clear and the expectation on the person engaging in simulation is that they should find that diagnosis pretty quickly and recognize it, and then they pass the simulation.

20:29SPEAKER_01:And I think the challenge is if people are in a simulated scenario where there isn't, or they don't reach a diagnosis or don't come up with the management plan, they assume that they failed the simulated scenario. So actually, some really interesting work at medical school to look at well, what happens if we deliberately write simulated scenarios that are ambiguous and are uncertain. And unsurprisingly, medical students don't like that very much, and it can cause an immediate, quite strong negative emotional response.

20:57SPEAKER_01:But but if they are supported well in that situation, if they're supervised and they're given a good post-simulated debrief in a psychologically safe environment, that immediate negative emotional response actually, in time, can translate into more positive cognitive and behavioural responses to uncertainty. So I think unfortunately at the moment, simulated scenarios often do the opposite of supporting people to develop more positive responses to uncertainty.

21:22SPEAKER_01:They definitely can, but they need to be carefully constructed, and the post-simulation debrief is incredibly important. The other way that simulated scenarios can help, I guess this is from my own perspective as a DME, is that when talking about the unnecessary uncertainty, actually, for us, one of the unnecessary uncertainties that people were experiencing as a new doctor working on a psychiatric rotation was how do I conduct a seclusion review effectively?

21:51SPEAKER_01:What are the expectations of me in regard to my relationship with the nursing staff? What is it I'm trying to do? So, actually, in hearing that, we developed As part of the induction before people are on call, a simulated scenario to try and help reduce that unnecessary uncertainty associated with that scenario. So when they're on call and doing clinical work in that scenario, actually, they're really engaging with the clinical uncertainty rather than what's what is my role here?

22:15SPEAKER_01:How should I manage the relationship with the nursing staff? What are the expectations on me, for example? Um, so yes, simulation can be a good tool, but there's also a risk if not used carefully.

22:28SPEAKER_02:And Lee, moving on from that, so we've talked a lot about ambiguity, uncertainty at medical school and postgraduate education. However, when we come to do summative assessments at medical school and postgraduate, we often use single best answer. Medicine isn't like that. So we're trying to teach people, doctors, about uncertainty and to sit with it. But then we're saying, actually, you can't be uncertain in an exam. Yes. So it's so it's sort of it's it's something that's baffled me for a long, long time.

23:08SPEAKER_02:Because I don't understand how we can expect uh trainees to understand uncertainty in the workplace, but when it comes to an exam, there isn't any.

23:22SPEAKER_01:It's difficult to do more than just agree with you there. I I agree. I think it's a real challenge. I think it is a real challenge that MCQs are fundamentally the things that are assessing whether medical students can progress or not. I mean, even OSCI's, although ISCI's OSCI is slightly slightly better, there are still, as I talked about simulated scenarios, there will be very clear diagnoses that the the learner is expected to reach and things that they're expected to achieve.

23:49SPEAKER_01:Um, it is a huge challenge, and we see that, I see that when speaking to medical students often, particularly at the time of year, will have a huge impact on how able they are to engage with other opportunities to learn how close is the next MCQ. Um, I think within some postgraduate specialities, it's obviously still a challenge. How can we get that right? It's difficult to have a single response to that because it's so ingrained within the practice and the assessments of medicine.

24:17SPEAKER_01:I think within psychiatry, we're quite fortunate that we don't have an exit exam. So all of our MCQs are done by core training. So actually, as a specialty doctor, you're more able to engage with those other aspects of training that are not the reliant or dependent on multiple choice questions, which I think is a positive. Um, and moving towards that, I think is really positive for our speciality. But yeah, you're right, it's a it's a big challenge.

24:40SPEAKER_02:Yeah. And I it's one that I venomemently disagree with because I'll look at a question I'm like, well, it could be any of those five answers, dependent on the situation that you're in. Um so it is a challenge. Should we reframe uncertainty as curiosity?

24:57SPEAKER_01:I like it. That's a positive rebranding. Yeah, that could be.

25:00SPEAKER_02:Let's rebrand it as curiosity. Because, you know, we want we want I'm, you know, curious, continuously curious. And instead of saying, oh, I'm I'm really not sure what's going on, I'm very uncertain. Oh, I'm really curious as to why I've come to hospital day today. Oh, yeah, I'm gonna do some tests and we're trying to figure out what's going on. Um, and maybe it's just lexicon rhetoric, I'm not sure, but I don't know. Trying to reframe in a positive stance.

25:25SPEAKER_01:I think you're right. I think positive reframing could be a really useful thing. I certainly when I hear my colleagues, I'm thinking it now about safeguarding concerns within uh mental health services and psychiatry, we talk a lot about professional curiosity. Yes, um, rather than uncertainty. So I think, yeah, curiosity, I I would see that as back at the start, I talked about the the the kind of emotional cognitive behavioural responses to uncertainty.

25:50SPEAKER_01:Curiosity obviously is a positive cognitive response to uncertainty. I think the more we can foster and support people to be curious, I think that'd be a really positive, positive thing. I think you're right though, there are kind of negative connotations with the word uncertainty, not just within medicine, but within society. Um so it is yeah, I think that's a a great idea.

26:13SPEAKER_00:Can I can I just extend can I just extend on that? Because um one of the questions I always used, I think clinical reason you can get the concept of search satisfaction and then confirmation bias. So you you get a bit like the scenarios you talk about, you end up doing the same patterns and you don't think outside the box. And I remember a very clear case of a paractival origin of a very small baby, and we were struggling for a long time to work it out.

26:41SPEAKER_00:And it was and my question was, what else could this be? You know, that we were saying it was automatic because of some bonyolytic lesions, and and this it was at that constant, this does not feel right. I always say to people, if you've come to a diagnosis, but what else could this be? How certain in dealing with that? And this child ended up having systemic BCGosis and severe combined immunodeficiency and at least reaction, but we got so fixated, and that links to the curiosity and for all of the clinical decisions.

27:14SPEAKER_00:I think it's this, but what if there is uncertainty? What are my options? I suppose how do I mitigate that and when do I know to go there but not be paralysed by that? Because I think sometimes if you have that constant uncertainty, maybe I'll just my things, I think sometimes you get paralysis of decisions and actions, and we spend a lot of money on investigations.

27:39SPEAKER_01:You completely agree. Yeah, I think paralysis of decision making is a real risk in this. I guess it's something I sometimes see in supporting resident doctors that when we're thinking about ambiguity, missing, imprecise, conflicting information, often particularly in older age psychiatry, for example, when we're trying to make a diagnosis or progress a clinical scenario, the right thing to do is to take a collateral history to try and in improve the quantity or the quality of the information that we have.

28:08SPEAKER_01:And I and you can see people getting stuck sometimes where they're unable to move on and make a decision because they're constantly or continually trying to reduce the ambiguity and they might have two or three collateral histories and they want a fourth or a fifth. I guess your experience might be actually a fourth of a fifth collateral here. No matter what it says, it's probably not going to improve our quality of information and put us in a different position.

28:30SPEAKER_01:We just need to make a decision and move on. So, yeah, so I guess supporting people to know when they have enough information to make a defensible and good enough decision to move on is really important. But yeah, as you're saying that the strategies you've talked about there are exactly the kinds of things we'd hope people would do with their resident doctors so they can see, you know, consultants really kind of yeah, channel thinking about this, struggling with this.

28:56SPEAKER_01:Not struggling, I guess that's a negative word, isn't it? But you know, sitting with this and working out how to progress in the state.

29:02SPEAKER_00:I think struggling's okay. I don't even negative things say actually this doesn't fit, it doesn't feel right. I'm struggling. Talk to me, have some ideas. Um I I was very known for my decisiveness. I was on the other end of the spectrum. Um, I'm also well known for my timekeeping. So we've coming close to the end, and I think we, as I said earlier at the start, I think we could talk for hours on this topic. Um, before I summarise, Amy, I don't know if you've got any final points or opinions.

29:30SPEAKER_02:Um, I guess there's one, I guess I guess it's more of a question or thought process or something to think about, is we've talked a lot about uncertainty with our students. It's the communication of that uncertainty slash curiosity to the patient. Yeah. And I think and I think that's where we can educate our trainees a lot by role modelling good communication of curiosity/slash uncertainty to our patients, and how can we do that in a good way that ensures the patient feels safe and the doctor feels safe?

30:04SPEAKER_00:Yeah. And before I summarize and take bring us to a close, Jason, I ask all of our guests this question, which is if you could go on a time machine with all of your knowledge and experience and give yourself some advice when that first year of being on the wards as a new as a new doctor, what advice would you give yourself?

30:26SPEAKER_01:I should have prepared for this question. I've listened to your podcast before, and I remember thinking how difficult a question that would be to answer. Um I think try I think probably this is not a particularly original answer, but I would try to encourage myself to it to enjoy the process as much as possible rather than seeking the destination. I think, you know, the I I I recall thinking let's get through training and get to be a consultant, and then I had a real wobble when I got to being a consultant, not because necessarily of the step up, but I just the idea of what next, what do I do now?

31:07SPEAKER_01:Yeah. And it took me quite a while to work out what I do next. Um, but I think just to try to enjoy the process, yeah, as much as possible, and enjoy the opportunity to do all of the specialties that you know you're never going to end up doing, um, which I think I did, but just do that. Enjoy the process, enjoy the journey. Thank you.

31:27SPEAKER_00:So I've always summarised just some of the learning I've taken away really. Um that uncertainty is different from risk. Uh, we need to be consciously aware of how this affects us in terms of our emotions, our stress, our behaviors at work. We should role model discussing uncertainty and vulnerability, which I think is good for the team. I potentially the patient, as Amy said, um, this is amplified um during transitions and improves this conditions.

31:58SPEAKER_00:And if we could reframe it from being curious. So, thank you very much.

32:05SPEAKER_01:Thank you for having me. It's been a pleasure speaking with you both.

32:09SPEAKER_02:Thank you so much, and thank you to all of our listeners out there. Thanks for listening. Goodbye.

32:15SPEAKER_00:Bye.

32:17SPEAKER_02:Thank you to everybody for listening. Please connect with us on social media at LinkedIn at Doctor's Training and subscribe to the channel. Remember, the bigger the show gets, the bigger the guests get, and the greater the defeat.

32:31SPEAKER_00:See you soon.