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Doctors at Work Podcast.

Episode #86

How do you become Head of the School of General Practice? With Manjiri Bodhe

Mat Daniel

10/05/2024

In this episode, Manjiri tells me how she became Head of School. We talk about the importance of role models in career planning, and discuss how as doctors we often have a very narrow view of the skills that we have. We discuss how some people have a tendency to talk themselves out of going for roles, and of the importance of confronting the fear that we have and consider what are the worst and best things that can happen. Manjiri tells me how one opportunity often leads to another, and that’s it’s important to have a mindset that looks for opportunities, development, and growth.

You can also watch on www.youtube.com/@dr-coach/videos.
Production: Shot by Polachek

Podcast Transcript

Mat: [00:00:00] Welcome to Doctors at Work. My name is Mat Daniel and this podcast is part of my mission to help doctors create successful and meaningful careers. Today I’m having a discussion with Manjiri Bodhe, who’s head of School of General Practice. She tells me about the importance that role models play when it comes to career decision making, and we talk about how as doctors we often have a very narrow view of the skills that we have.

We discuss how some people have a tendency to talk themselves out of going for roles. And instead, they need to confront the fear and consider what’s the worst and what’s the best thing that can happen. Majiri tells me that one opportunity often leads to another and that it’s important to have a mindset that looks for opportunities for development and for growth.

Welcome Manjiri, tell

Manjiri: me a little bit about yourself. Hi Mat, thank you for inviting me. So, um, I’m a GP, uh, been a GP for about 20 [00:01:00] odd years, um, and I have a portfolio career. So lots of different parts of being a GP as well as doing some, um, private things on the side. And I’m also now mainly head of school, GP school for both Wessex and Thames Valley for NHS England.

So that’s me.

Mat: And I’m interested in your role as being head of school of general practice. Um, and we’ll probably talk a little bit about. You know how you got there what kind of skills you need to succeed But maybe a starting question would be what attracted you to that role in the first place?

Manjiri: So I think I hadn’t actually particularly planned to get in that role, but what I had planned to do was be in medical education, which is how I started, um, which was being a bit of a trainer, a GP trainer and, and within the GP training program.

I think the thing that attracted me to medical education is the, the whole bit around, um, doing education with trainees. Um, so either doing one to one education or being in [00:02:00] charge of some of delivery of the curriculum. And I think the main thing is working with a team of people who are just as passionate as you about it.

Um, everyone has opinions. Um, it’s quite a collaborative approach, which I think for me is always the key in teams. And certainly in GP teams, there’s the kind of teams that are. I worked well with. So it’s that bit about being passionate about education, but also working in a very close knit team with with people that are really bright and eager and everyone is a leader in their own right.

So that’s really what attracted me, I think.

Mat: Maybe if we kind of start at the beginning of your career, when did you first know that medical education was something that was of interest? So actually,

Manjiri: when I was training, when I was in my own GP training program, my mentor was my trainer, and a lot of what he was doing sort of really appealed to me.

He was a fantastic trainer and sort of a mentor to me for many years subsequently. [00:03:00] And I loved the way he could get the best out of you, sort of find out what you wanted to do and sort of help you along the way. There wasn’t any pointing you. Um, but it was just helping you, you come to your own decisions about what is best for you.

Um, and so I, I think from that point, I thought, Oh, this, this is something I want to do when I feel ready. And actually, when I then subsequently joined the same practice as a partner a few years later, that was one of the things that they wanted. He was leaving and they wanted someone to take over the training.

And so it sort of naturally felt, it felt all that, that fate had brought me to that point, but that’s where it started. And I think everything that I’ve done is because. I’ve had people that I’ve interacted with doing that, those roles that have been fantastic. And so they role modeled what those roles could look like for me.

And I think gave me the passion to think, actually, it’s something really fantastic that I want to do as well.

Mat: And this sounds really important for those of us that are senior doctors is, you know, recognizing that you are [00:04:00] where you are today because of the way a senior doctor interacted with you and actually the same for me.

I am where I am today because of the way senior doctors Interacted with me. Um, I think I think sometimes the senior doctors we forget the influence that we have on others? Do you think, is that the fair comment, do you think?

Manjiri: I think it’s a fair comment. Sometimes we feel trust upon in those roles and think, why should we be role models?

But I think if you go into any profession, that is, that is exactly what it is. You’ve got, you’ve got experience, you’ve worked your way around systems. You may know something that someone who’s just starting up in that profession may not know. And I think just that, that little bit of. pointing in the right direction or giving you some advice, not telling someone what to do, but just saying, this might be great, or this, this is something I’ve found out that you might want to look into.

Just that, that little bit of support and collaboration goes a really, really long way. And I think as medics, we [00:05:00] all know about people that we wouldn’t want to follow that we’ve had, um, as senior doctors, um, that we’ve worked with. And we kind of know what that looks like, but I think it’s really harder to sort of think about.

What a good role model or someone role modeling, uh, a leadership role who’s good looks like. Um, and I think what it looks like is someone who’s a facilitator who supports you, collaborates with you, doesn’t tell you what to do, but, but does find out what you want to do and sort of helps you along the way.

So I, it’s absolutely important. And we, we are the people that quite often as senior people are often in that educational role, whether it’s informally or formally. Um, so even those that are not trainers are going to be debriefing, going to be talking about cases with trainees. So yeah, absolutely. I think that’s such an important role.

Mat: And what would you say, you know, somebody, a senior doctor might, might come back and say, I’m busy, I’m stressed. I have so much to do. You know, [00:06:00] what, why should I? Make this as a priority. So you know why? Why should we, a senior doctors make this role modeling a priority. I

Manjiri: think I always put it back to my own experience.

I think I think back to if someone I mean, I understand people are busy and and I take that with with with a pinch of salt in that when someone is busy and they say I don’t have time. It doesn’t always mean they will never have time. It might be in that moment. They don’t have time, but they recognize they will make time for you later.

Um, yeah. I think everyone that I have used as a role model has found some time for me. It doesn’t have to be an hour. It sometimes only needs to be a couple of minutes. Even if that couple of minutes is, I really want to help you. I’m really stressed at the moment, but shall we make some time later on? So it’s just taking that little bit of care to think about Everyone is busy, but actually how we treat our peers and our colleagues is so important.

If you ask anyone why they left a job, it won’t be because of the job. It will [00:07:00] be because quite often the people they’re working with weren’t the right fit for them. And we often leave jobs because of those situations. So that team and the people that you work with, whether they’re senior or, you know, um, less senior than you.

It’s so important in a job. And I think making time for those people that want to link with you, that you can be a mentor to, is very, very important. I think we shouldn’t underestimate it. And yes, you know, everyone is very, very busy. It’s a horrible, horrible time in the NHS. But I think even making a couple of minutes of showing someone a bit of care and attention and pointing them in the right direction, is really important.

I think, I think you underestimate how that can affect the other person. And actually,

Mat: I really like this idea that I might be busy right now. And you know, and I might not have an hour right now, but I probably have two minutes. Yeah, realistically speaking, I have two minutes to listen. Or, you know, or if it’s something that needs an hour, then we can organize that on another occasion.

So that strikes me as a really really important insight. So if you go [00:08:00] back to your career, so you knew that medical education was for you. Um, you know, there’s a real skill in being a good educator and there’s a real skill in being a leader. Um, when it comes to medical education, how, how did you develop yourself?

How did you develop the skills needed to be where you are today?

Manjiri: So I think, I mean, I personally think medical education is fantastic in our country. I think particularly in general practice, the, what we call the VTS scheme, the vocational training scheme, some people call it the day release scheme has been going for many, many years now.

Um, and embedded into that is this peer support, uh, ballot groups, you know, a lot of that is embedded in the VTS scheme. not just in the training, but in the trainers as well. So not only do the trainees get that as part and parcel of their weekly day release, the trainers have very solid groups that they come together and they share what is going on with training and I think learn from each other.

Actually, I was so surprised to find the [00:09:00] variety of just people who take up training and the vast, um, kind of amazing kind of qualities that they bring to it. There’s things like humanities in sciences. There were people that had done art that had done ceramics, that had, um, done something completely different to medicine, um, that wrote, writing books, and so brought that into their training.

Um, and so it was very vast, different tutorials that we were teaching ourselves to do. So how do you use the arts in medicine? Isn’t that two different complete things? Amazing. So there were these really rich conversations happening in our groups, which I think helped and then being a curious person yourself, you know, wanting to better yourself in inverted commas, wanting to find out different aspects of your own personality, which will then help your trainee.

And I think we learn as much from our trainees. I mean, medicine wise. I think our trainees are more up to date than we are. So there was that exchange of constant exchange of information. The trainees didn’t feel they were lesser because actually they were teaching us [00:10:00] all the time. Uh, I think softer skills, we probably had a lot to teach them such as communication skills, but actually the pure medicine, we’d be finding out things that were happening in hospitals 10 years.

So I think that exchange and being able to, um, Formulate those relationships. And I think the key is the relationships for me, um, all those relationships you build with your trainees, with the other trainers, uh, if you’re doing some small group work with other trainees, that, that, that kind of amazing feeling of actually, I do know something I can impart something that might help one or two of these trainees.

Um, so that, that was kind of going on in the background and I think it’s that constant, you know, I know self-improvement is a bad word for some people, but, but it is that, isn’t it constantly recognizing areas that you think, oh, I could, I could do this differently or do it better? Mm-Hmm. . Um, and I just, I loved all that and I love reading.

So, um, I brought that into my training, I think, and, and I got my trainees to read books. I think [00:11:00] nowadays there’s not as much time and the generation is slightly different. I don’t, I think they’re more likely to listen to podcasts like this. Um, but, but I use those, I use podcasts. Um, I used, um. videos in my tutorial.

So made it really interactive because that’s how we learn, isn’t it? And that made me a better person. I think, I think it made me a better educator as well.

Mat: So what, what did you need to do to become a GP trainer?

Manjiri: So, um, In the old days, it has changed now. In the old days, you had to do a PG cert, um, and different areas, different deaneries had different ways of doing it.

In Oxford, um, now Thames Valley, um, the PG cert was delivered locally, um, to a group of trainers. So you had three weekends where you’d go and do the formal modules, and then in between you had to do reading and do your essays, and they were moderated and checked. So you did all that, and then during that time, you also joined the trainers group.

So you started. Getting a feel for what trainees are doing and, you know, how, [00:12:00] how you might be training. If you were in a training practice, that was easy because you had access to trainees, but I wasn’t. Um, but you could, you could do some tutorials with your nurses, for example, do some education with your peer groups.

So it was, the idea was to practice and think about how you would use that educator state within your practice. So that took about nine months to a year, that whole process. And then following that, you have, in the old days, you had an approval visit. Now it’s just a, um, an online process. Um, and you’d show yourself doing a video of you teaching someone.

Um, so it could have been a nurse in your practice, or it could have been another, um, junior doctor, or whatever, whoever’s available. And you could borrow a trainee from another practice if you kind of wanted to as well. So you had to show, demonstrate what you’d learned and, and, and, and sort of, and then, and then they approved you to actually become, um, a trainer at that point.

Yeah. Um, your practice would also have to officially become a training practice. So there were a few things that the [00:13:00] practice had to do to, to do that as well. Um, so that was the process. So it did take quite a while at that point. I think the process has been slightly shortened now, um, to try and encourage more people to do training.

Yeah. Um, but it was a great, it was a great learning year, I think. Um, yeah. It’s

Mat: and it sounds it sounds very comprehensive and much more detailed than I think what happens in secondary care because you know, by and large, everybody’s a clinical supervisor, and you know and you do some online modules. I mean, it’s, I suppose, I think the quality of the training varies widely you know if you take the time you do that you do some face to face development it’s good.

Or you can do some online modules, but I think the having to demonstrate the quality. of yourself as a trainer. I, I don’t think that anybody, anybody in secondary care has ever asked me to demonstrate my quality, but you know, but maybe people should. Yeah. So, um,

Manjiri: yeah, I, I mean, I think [00:14:00] GPs, we pride ourselves on the quality of how we teach and the education we deliver.

And I think one of the reasons is because we’re not in a group of people generally when the trainee is with us, it’s, it’s fairly one to one in the sense that they are in the room on their own and you are then supervising them going in and having a discussion post a patient. It’s quite, it can be quite isolated, but it also is.

Quite scary because you’re doing it completely on your own. You haven’t got a team of people like you have in the hospital. You haven’t got associates there. Um, you haven’t got the hierarchical difference. But also, that can be Quite good in the sense that you’ve got multiple numbers of clinicians around you.

And in general practice, you just don’t. You are in the room with the patient for pretty much the whole day. So I think the quality is the robustness of being able to supervise someone who essentially is working on their own. Um, and preparing you for how to do that supervision is so important. But I do think that one to one supervision is what trainees often [00:15:00] talk about in general practice.

They really appreciate it. Thanks. It’s quite a holistic approach, which is sort of our specialty, isn’t it? Um, and we kind of take our education in the same way. So we do, we do feel that we do something that little bit extra. Um, and I think it does stand us in good stead as educators. Definitely, I feel.

Mat: If I, again, if, if I think what happens in secondary care is a lot of what I hear is, you know, people say that, They don’t know who the consultants are.

You know, they don’t meet the consultants. There’s no interaction. And, you know, maybe sort of in my role that, that I, that there’s a registrar that I work with and, you know, and we operate together and we do clinic together. So with that person, we work very closely. Um, but there’ll be lots and lots of maybe other specialties that there isn’t sort of that operating clinic experience and that the model that that’s been developed in general practice, you know, sounds really, really rock solid that, you know, apprenticeship and that one to one connection between two people, but where that, you know, [00:16:00] real, real feedback trainees developing, which, which I, I, I suspect that that’s disappeared in an awful lot of other areas of medicine.

Manjiri: It is, and sadly, I think because of the numbers, we’re, we’re slightly, it’s a slightly risky situation in general practice. The number of, uh, supervisors, we just can’t get enough supervisors and the number of general practice trainees is going up as part of the long term workforce plan. So we have to try and keep as much of that one to one as we can whilst being able to deliver the capacity.

It’s sort of that balance between, um, Um, how do you keep that relationship, which is I think why I found my trainer such a mentor because that relationship was there. Absolutely. Yeah.

Mat: Yeah. Because you know, if you’re not careful, it’s going to be that you’re going to work with people and they’re going to, they’re going to work with you for four months.

And then at the end, they’re going to come. Can you do my assessments and you can say, I’ve not, I’ve seen you once. Yeah,

Manjiri: so that’s a scary thought, isn’t it? Yes, absolutely.

Mat: You know, that, that’s just, that’s just terrible, isn’t [00:17:00] it? Sort of that, that model of working, but I do think that happens a lot, unfortunately.

Okay, so, so you, you then, you become a trainer. So how did you go from being a trainer? to being head of school of general practice.

Manjiri: So really what kind of happened is I was a trainer and I did sort of locum and salary bits and then I ended up being a partner in the practice where I started as a trainer and I was there for 11 years as a partner and during that 11 years general practice had really changed quite a lot towards that last part of the 11 years.

Um, we find it really difficult to get partners. So when partners left, The partnership model was starting to get quite strained. Lots more people becoming salaried or locums. Um, and the workload was, was getting beyond something I could manage. I had youngish kids at that point. Um, and, and I’d been thinking for a little while that, um, what do I do?

How do I, what do I do now for the next period of time? Do I stay in the partnership? And actually at that [00:18:00] point, um, a role had come up for, uh, uh, the training program director locally, TPD. Great. But I sort of taught myself how to be even applying for it because at the point it would have had, I would have had to reduce some sessions at the partnership and we just agreed that everyone in the partnership should do a minimum number of sessions to keep the partnership going so it wouldn’t kind of fall over really.

And so I didn’t feel and we’d refused someone else stopping and changing and I just thought I can’t, I won’t be given permission. It doesn’t feel fair. So it stopped me applying for that role. But I really wanted to apply for it. I knew the area really well. I knew everyone in the area. I was very active in my trainers group.

Um, and even then I was the chair of the trainers group. We used to have a rolling chair for three years. I did that. So I, I knew that was. That was where I was heading in some form. And I was really frustrated because I felt like the, that portfolio bit wasn’t opening up to me because of the partnership.

So I made the difficult decision to leave the partnership at that point. [00:19:00] And actually I ended up becoming salaried in a, in another practice. And that’s really when, um, I started looking at sort of more medical education, more the senior educator role. So rather than just the trainer, um, and I do have some coaching at that point, because I was a little bit confused as to.

What do I do? How do I do it? And a friend of mine was doing her coaching qualifications. Um, and she coached me and it just opened up a whole different way of me looking at my career and, and it really helped me sort of just go for things. So not, not sabotage myself before I try. Um, and I also did my coaching and mentoring course at the same time.

Doing all that, I thought this is, this is really going to be useful for me. This, this sounds exciting. So I started that and whilst that was happening about a year after I’d done the coaching course, a role came up in medical education again. Well, there were three roles. And, um, again, I sort of started thinking, should I apply?

I don’t have much experience. Um, I don’t know if I’m right for [00:20:00] this role. Uh, sort of again, talking myself down before I stepped into that. And it is, I’ve talked to other people. Women particularly tend to do this a lot. Um, I don’t know what it is. Maybe it’s a, a, a, a longstanding thing. It’s how we’re conditioned to think about ourselves.

And a lot of my friends and us, we’re all very similar. So talking through that was useful. Um, but the coaching really helped with that. And in the end, I spoke to the director at the time, the, the, the Dean, um, and he just said, Apply for them all. So you’re perfectly capable of doing it. Um, yes, you haven’t got experience, but that will just mean you have a couple of months where the learning curve is a bit steep, but you’re perfectly capable of being able to have that learning curve.

So that sort of Just that support gave me the step forwards and I applied for all the roles and I got the role of associate dean. And generally what normally happens is you become a TPD and then you step into associate dean. But I hadn’t done that so it was a bit of a [00:21:00] learning curve. But that was basically a day and a half that I did that role in.

And it was fantastic because it was a mix of roles. I really got to grips with the kind of the leadership part of medical education and understanding how it’s all set up. I think as an educator, as a, as a trainer, you don’t, you don’t really see that side of things. It’s like any role, isn’t it? Unless you step into the role, it’s difficult to know what you do.

I mean, the public often struggle to understand what we do as doctors. Um, and, and it’s kind of like that in medical education, until you’re in it, you sort of don’t understand the whole breadth of it. Um, and I absolutely loved, loved that. So that was my first kind of senior role, I think, um, in medical education.

So yeah, I did that for about 18 months, um, when I was doing that. Um, and then the Dean decided to retire at that point. And in fact, one of the other ADs who was a extremely experienced AD, we all had known him for a very long time, um, Absolutely [00:22:00] fantastic. Another guy that really is like a role model. You kind of think I want to be like him.

This, this is my ideal person as a medical educator. But he also, we all thought he would be applying for it, but he at that point decided that he wanted to leave and he was doing some other directorship roles. We were all very, very upset because he was kind of I think someone that we all looked up to and, um, we emulated and, and, and he had amazing advice and experience.

But basically at that point, then it was who was going to apply for this role. Because generally it’s, it’s good if someone in the team has that aspiration because it’s sort of succession planning and, and, you know, um, people know other people in the team. I don’t think anyone else wanted to do it. And so I kind of, you know, The Dean sort of spoke to me and I was like, Oh my God, I’ve only been in this for 18 months.

I don’t think I’m ready for this. And he said, again, he said, I think you’re ready for it. Again, it’s a steep learning curve, but I [00:23:00] think you’ll be able to step into it. And I think it’s worth it. These opportunities don’t come all the time. So he said, I think it’s worth you going for it. So I think just that support again, I was like, I think the coaching had changed my brain in that what is the worst that can happen?

I might apply for it and decide I don’t want it, but I might apply for it. Take the role, decide it’s not for me. Um, I can leave. I’m not tied into something or I take it and it might end up being the best thing I’ve ever done. And it was the latter of really. So at that point, um, I took it out. It was literally a month before COVID started.

Um, I took the job. Um, yeah, so that’s, that was my journey to becoming head of school really.

Mat: I hope you’re enjoying the show. Please click subscribe so you’ll be notified when new episodes become available. This podcast is part of my mission to help doctors create successful and meaningful careers. You can be part of that mission too by forwarding this show to one person who you [00:24:00] think might benefit from listening.

Thank you. Now on with the

Manjiri: show. I’m,

Mat: I’m really interested in this idea of kind of talking yourself out of it. And you know, I’m not ready. I don’t have qualifications. You know, it, it’s not for me. And I agree with you. I think, I think that happens an awful lot, isn’t it? That, you know, I’m not ready. I don’t have the right qualifications. Um, and I mean, how, how, how does somebody manage sort of to, to overcome, you know, that, that, that doubt that this is the right thing to do?

Cause you just went for it and you, you know, you, if you think you reside, you left, you left a good gig, you know, you were a partner. Yeah. So, you know, you left something really quite good in order. To move into direction and you had no idea whether it was going to pan out or not. Yeah. I mean, as it happens, it’s been brilliant, but you didn’t know, presumably, did you?

So what, what gave you the courage to sort of, to just put yourself out there and just go for it and expose yourself, be vulnerable, [00:25:00] be ready to be rejected, be ready to fail. Yeah. You know, what, what enabled you to, to do those things?

Manjiri: Yeah, so I think I have to acknowledge the privilege that I have that I’ve got a partner and so therefore there’s a little bit of flex there within our home situation that both of us work.

So if one doesn’t have something for a while and the other does, we can manage. So that, that’s a privilege not everyone has, and I accept that it won’t be as easy for everyone. But I think that that’s the key, is that Talking to people around you, so getting the support, getting the sound boards from people you know, I think is really important.

I don’t think that’s always the final bit because people you know haven’t got objective views on you, they’ve got subjective views, they’ve got skin in the game, they might want you to do something or not do something, so it’s good to get the views but I don’t think that should be your final resting place in terms of the decision making.

For me, it was getting that objective person to challenge me and ask me the difficult questions that really helped. So that original bit of coaching that I [00:26:00] did, which was about questioning, why do you sabotage yourself before you go for things? What, what is the fear that you have? It was verbalizing all those things that really helped me because the fear I had was Well, what if I get, for example, that job that I didn’t go for?

What if I get the job and then I have to speak to the partnership? Okay. So what if you have to speak to the partnership? What’s the fear about that? Oh, they’ll think badly of me. And, and, you know, but, but, but then beyond that, what happens if they say yes. So we just, they just kept, Pushing me to ask me what was the fear, what was the challenge?

And then how would you deal with that challenge? So it took me beyond just the fear and stopping. It said, yes, there’s a fear. And of course there is, there is a pro and con to everything. What is the worst that could happen with that fear? And what is the best that could happen? So it helps my thought process.

I think. Go through the entirety of that thought process rather than stopping at the fear on often. That was where I was stopping at. Well, if I have to ask the partnership that that’s too much effort, and it [00:27:00] might go badly. So therefore, I don’t want to go beyond that. When actually, then, well, if it’s if it can go badly can also go well, there’s a 50 50 chance of that happening.

So what’s the flip side of that? What happens then? Oh, then they might give me the sessions. They I might get the job and I might have this portfolio career. So I think After that first bit of coaching, it stuck in my head and I don’t know why I think because it was so effective at that point, it worked really well for me.

I think that’s how I look at every opportunity. Now I sort of go through that process in my head in a way and think about what’s the worst that can happen. What’s the best that can happen. And I have to think of both. If there’s one, there’s got to be another. Um, you know, if I cross a road, I’m I could die, but then the other side is I could cross the road and carry on with my day.

Um, and it doesn’t stop you doing it. Do you know what I mean? So, that’s the process now that I kind of go through in my head whenever I’m thinking of big decisions. But I do, I talk it through. Generally with family, I talk it through with my partner. Um, I [00:28:00] talk it through often with my colleagues, friends, friends who are colleagues, because often we’re going through similar, similar things and it can be really insightful that someone else might’ve had an experience that might be helpful for me.

So that’s how I work my way through a decision. And what I’ve realized is that as medics, we often sell ourselves quite short about our. About what, what skills we have, because we think our skills are limited to medicine, but actually they’re not the skills that we use in medicine are actually wider professional skills and life skills.

And I, I think we’re so ingrained in that medical model that we, we forget that actually we are still professionals of a sword and we have all these, all these skills, you know, lead a team. You make, uh, life and death situations. Um, you decide when you’re fit enough to go to work or when you’re too tired and you shouldn’t do something.

Now, these are all skills that we learn that can follow through to other things. Um, and we’ve got to remind ourselves of that, that [00:29:00] it isn’t just for medicine. These skills can be used other. things as well, other professions.

Mat: So why do you think, why do we have that very narrow view of what we can do?

Because, you know, I’m loving this idea that, that, that, that, you know, there’s a world out there, you know, within medicine and also for some people outside of medicine. Yeah, but, you know, there’s a world that isn’t frontline clinical care. Um, and, and You know, for me, I love that world because I spend a lot of a lot of my time in that world in exactly the same as you and you know, for me, it really, it enriches my clinical practice.

It gives my career longevity. It makes me a better clinician also because I do all of those sort of additional things, you know, that makes me better with my patients, better educated, better surgeon. Um, but what, what, what kind of, what gets in the way, you know, why, why do we have that really narrow blinkered perspective?

Yeah.

Manjiri: I think it’s probably historical and the vocational aspect of doing medicine, which [00:30:00] Historically, I think, was very ingrained in any of the caring professions. Um, if you think about nursing, if you think about, um, uh, you know, uh, any kind of medicine, um, that was part and parcel, that that is what you’re trained to do, that is what you do, and you will do that for 40 or 50 years of your life till you fall over, uh, you know, whilst you’re working.

And I think that model is is slightly being dissipated now that that is not the case. And I think more importantly, that actually generations coming that that retirement age or that stopping at a certain point and not doing anything is going to go, you know, their careers are going to look very, very different, I think, from from yours or mine’s or anyone maybe even 15 years ago, um, and they might be working for much, much longer and to expect someone to do the same job over and over for 40 or 50 years, uh, I think is just not, not, not, um, doable actually long term.

Um, you don’t grow, you don’t challenge yourself in those ways. [00:31:00] Do different things. And as you rightly said, you pinpointed that actually you doing things out of the frontline clinical actually enhances your frontline clinical. And I think that’s absolutely true. A lot of trainers do training and teaching because it enhances their clinical work.

It makes them better clinicians because they’re understanding why they do things they do. They learn new clinical information so they can be up to date with their patients. Um, and I think it, um, and I think that’s absolutely true. The different roles mean that you, you are re energized for that role when you go back into those roles on different days.

So I think actually, realistically speaking, for this generation, they’re going to be working a very long time and, and so that variety and challenge is going to be needed. I don’t think you can do, um, one thing for the rest of your life. And I do think because of technology things are changing and I think we’re going to need to be quite agile.

We don’t know which parts of our role are going to be taken over, um, by technology and AI and which bits will remain. I think lots will remain. The human touch is important. [00:32:00] Um, it’s, it’s, it’s part of who we are, but how much of that will be needed compared to how much can be automated is the question. I don’t think we know what that balance will be like.

So I think we need to be agile and be able to move about within different roles so we can then sustain ourselves.

Mat: And what kind of a mindset do you need to have, you know, to be agile? You know, if I think for your career, you know, you, you, you went for it, you know, you applied, who knew if it was going to work out or not, but you know, you did go for it.

So, and if you think of, you know, people who who do need to, you know, look at portfolio careers or, you know, every 10 years there needs to be a bit of a career reinvention. I’ve done that for 10 years. It’s all a bit samey. How am I going to sort of flex sideways a little bit? What kind of mindset do we as doctors need to have to make the most of that?

I think

Manjiri: you need to be quite open to change. And I know we’re open to change. A lot of us in the clinical side of things, you know, we’re used to [00:33:00] guidance being changed every five minutes. I think as GPs, we can’t keep up. Uh, it’s constantly changing. Um, but it’s this bit about growth mindset, isn’t it? It’s being taught to children now in primary school.

Um, and there’s reason for it because actually this bit about resilience, when we talk about resilience, isn’t about, Putting up with, uh, lots of rubbish systems. Resilience is being able to adapt to a system and make it better for you. Um, so I think that’s what resilience is. And that requires a mindset where actually, if things are changing, you might be able to change with it and see how it might benefit you.

Um, and so. Society is changing quite quickly. I think over the last five or 10 years, we’ve, we’ve all seen that. And I think everyone feels a little bit exhausted by change because it feels like change for the sake of change. I don’t think it is. I think generations and society does this all the time. You know, every decade that you look at, there’s been some sea changes.

Um, and, and [00:34:00] some people find it a bit discombobulating and others find it, you know, um, Absolutely exhilarating. And I think most of us are somewhere in between that we don’t mind change, but we would like it to be a bit slower. Um, and so I think what you’ve got to accept is that if there’s one thing that’s going to be a constant is that things are going to constantly change because we’re in a world where technology, it’s such a big part of it.

And that, that in itself is, is very, very quick change happening on a day to day basis. So that growth mindset is really important, is don’t be closed to something because you don’t agree with it. Be open to listening everything about that and then you can make up your mind in a very balanced way. It is tricky though, it’s difficult.

We’re all a bit tired and a bit stressed and the growth mindset can be difficult when, when we’re not in the right state of mind. But I’d argue that actually we could be less stressed if we keep ourselves in that growth open mindset, because things won’t bother us as much if we know that actually we can adapt to it.[00:35:00]

Mat: What’s coming up for me there also is acceptance that things are the way that they are. And, you know, and, and there are some things that we can change and, you know, sort of you, you and I can change and, and, and everybody else out there can change, but there’s an awful lot of stuff that, that, that, that is just unchangeable or certainly not immediately changeable.

And then it’s, it’s when you are. So when you let that grind you down, you know, if you sort of spend all the time trying to fight against it, you know, that’s exhausting, isn’t it? Yeah. Sort of. Whereas the alternative is, well, you know, this is how the world is. And how can I position myself so that I can take advantage?

you know, of that. Yeah. And, you know, certainly technology is a great example because there’s a bunch of doctors out there that are absolutely thriving on technology, aren’t they? You know, they’re, they’re running companies, they’re, they’re entrepreneurs, you know, they’re sort of taking part, you know, in, in various NHS programs.

Um, they’re, they’re, they’re, they’re Working as medical advisors, you know, the, or the, they’re in, they’re in [00:36:00] the venture capitalism, you know, all of that kind of stuff, um, that, that some of us, some medical people are absolutely thriving on that, aren’t they? And then there’s sort of, then, then there’s some other people that, that, that, that sort of saying, well, you know, this is all awful.

Um, and, and that’s probably, it, it doesn’t do them any favour because, you know, because it just is, isn’t it? So, you know, so what’s the point, what’s the point in, in fighting it? It’s just how it is.

Manjiri: Yeah. Yeah, I mean, there’s this thing about, um, uh, front runners, aren’t they? And then there’s people in the middle, and then there’s the laggers.

And the front runners are the ones that, In fashion, it’s like a trend, you know, that they’ll be there before the trend becomes a trend. They’re right at the beginning of it. They’re there before anyone knows about it. And there’s lots of doctors that are doing that with AI and health companies. And they’re out there and they’ve been doing it for years and years.

It’s now that obviously it’s coming into the mainstream. And so the majority of us are in that middle bit. We’re like. Yeah, I want to use it, but I’m not quite sure how to use it and how is it going to [00:37:00] impact on me day to day. And we will take it up. We will start playing with it and be able to use it.

And there’s those that are laggers that are absolutely don’t want to use it until it’s fully established. And it’s either made compulsory or it’s part and parcel of their work life. And that’s the case for anything, anything where there’s a new technology or something happening. That is how it is. And, and There will be people right at the front getting, getting the bits, doing the, I don’t know, getting the politicians involved, getting stuff embedded, all of that.

And we have to be thankful to them because without them, we’d have no innovation. Um, I am in the middle bit. I’m very likely somewhere in the middle. Um, and, and, but I, but, but I see potential. Um, what I am not is necessarily say a techie. So I have to go to a techie to understand what we’re dealing with.

And it might take me longer to understand that. So I know even as a leader that I’m not, I’m not going to be in that being able to lead it, but I can I can [00:38:00] grab someone else’s coattails and say, You’re doing this amazingly. How can we implement this now into a way that’s sustainable for us. And then we bring the laggers along because we show them we put the process in place and show them how it’s done.

So I think that is the case and I’m thankful that we’ve got these portfolio. Doctors now because without them actually quite a lot in general practice, for example, if you look at our I. T. Systems, a lot of the cloth work that’s being done all a lot of this with doctors who started companies, um, who understood what it is that is needed, for example, in in the primary care model and then are putting that in video linking accurate as a, you know, texting patients, etc.

All of that was set up by doctors who were doing it and realized there’s a gap in the market and actually this would work really well. So we need those, we need those people, you know, we need those people and they’re the true growth mindset, aren’t they? They’re sort of like, oh, this is amazing. Let’s run with it sort of [00:39:00] scenario.

Um, but yeah, I, I, I just think. We’re not all going to fit into one box. We’ve got a variety of people, but I do think we should, as doctors, think of ourselves as things other than doctors as well, because there’s so many things out there that being a doctor really gives usefulness to. Um, and, and, and we aren’t just doctors, I don’t think, even though being a doctor is a real privilege and it’s an amazing thing.

But it filters out into so many other things, I think. If

Mat: I go back to your role as head of school, what are the most challenging aspects of your role?

Manjiri: So I would say the most challenging aspects, I think, are the politics involved in terms of implementing any New, um, ideas or implementing anything new, uh, that relates to training in general, whether that affects trainees or trainers or both.

Um, so I think, um, certainly over the last few years, the politics, I think post pandemic, the politics [00:40:00] have become much bigger, um, because of the nature of what’s going on. You know, we’ve got significant issues with the NHS. Um, we’ve got significant funding issues. We’ve got an aging population. Um, We’ve got a reduction in the number of GPs that are actually working on a full time basis, um, and the total number in the country.

I think we’ve got the lowest number of GPs to population count. In Europe. Um, that’s pretty significant, really, um, for a public health system. So we’re dealing with that, but we have got increasing number of GP trainees. So the numbers that we are training are increasing, but we’re struggling to get the number of supervisors to to match the number of trainees because I think the system is grinding a lot of people down at the moment.

Um, to me it feels like this is the worst it’s ever been in terms of how the NHS is and the level of, um, acceptability and contentedness in the [00:41:00] staff really. So it feels like this is going to have to be a sea change in how the NHS conducts itself. I don’t know where it’s going to come out in the end.

And we’re always going to need doctors, but there is a little bit of a Threshold at the moment is how many doctors and will we need as many doctors? Are there other health professionals that are going to do some work of the doctor? It’s actually a very unsettling time for, for general practice, particularly.

Um, so people are questioning what is their role in medicine? And I think a lot of people are jumping ship and going into other things because they feel they don’t know whether this, this particular, um, role is, is, is going to be the same role that they trained up for. Though it is, it’s a little bit, um, It’s a little bit of a change at the moment.

Well, a major change, I think. And so, yeah, it’s navigating that is tricky. Um, and navigating the, I think we’ve got an aging population and the population demands have increased. Uh, you know, it’s, it’s normal. We’ve got a population We can treat more things, [00:42:00] more people want to be well, um, and so therefore they’re coming in more.

And I think post Covid the mental health crisis has been significant really. I think a lot of people have had real issues post Covid and we haven’t got the services for that. So we’re struggling with all of that and our trainees are part of that, they’re in that system and they’re seeing that system and they’re Maybe thinking, do I want to come out and work in this system?

And I think some of them are slightly unsure about that, actually. And

Mat: what are the best aspects of your job?

Manjiri: The best aspects of my job are that can be the worst aspect. They’re the two, the two sides of the coin. They’re the, I get to help the trainees, um, get into the training program, have this amazing varied training.

And as you mentioned, with this really high quality of training, our trainers are amazing. Um, and come out the other end as these fully fledged GPs being able to work independently. Um, but I think not just GPs, they’re, [00:43:00] they’re, they’re an entire fully fledged doctor, with a holistic approach, is my feeling.

And we’re quite unique, I think, in medicine, in that we’ve got that. we’ve got that ability to be able to bring everything together for a patient. Um, and that’s, that’s a privilege really, when you know that you’ve done something for a patient that is really positive. Um, you can’t underestimate that, that feel good altruistic feeling, um, that happens.

And when patients say that to you, you know, so that, that can’t be underestimated. Um, but the flip side is that the days that are not as good come at the same time, you know, they could come in the same week on the same day. Um, So that’s tricky is that that pressure to see lots of patients and deal with quite complicated patients actually in a small amount of time, um, some of our elderly patients.

Take, you know, 20 30 minutes and you might have 15 minutes to deal with them. And so that time pressure builds up during the day or during your clinic. So it’s, it’s the same coin, but actually when you’ve done a job well, you’ve done the job well, and you’ve done it safely is important. [00:44:00] So yeah, it’s part of the same thing.

Mat: And maybe if I can ask you to summarize, we’re coming to an end, what would be your top tips for doctors at work? So I think

Manjiri: top tips for doctors at work are, um, think about yourself because you are key to how you treat patients if you’re not well, and you’re not feeling content, and you don’t feel right in yourself, you can’t do your job.

Um, I think, think about having a portfolio career I think it brings richness to your, your life and to your clinical work as well. Um, and I think Think about your career a little bit more structured. So you think about speaking to a coach or a mentor or having something a bit more formal, um, and talking through that at an early stage and at intermittent stages, I think we’re probably the only profession that doesn’t get offered coaching as a routine.

Um, and so I highly recommend it in terms of getting your thoughts into gear and planning your career. I think always. It’s nice having a plan even if it never goes to plan, [00:45:00] um, is always my theory. So yeah,

Mat: wonderful. Thank you very much Thank you

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