What do we know about the F1 career transition? With Wen Wang

Mat: [00:00:00] Welcome to Doctors at Work. My name is Mat Daniel, and this podcast is about doctors’ careers. It’s part of my mission to help other doctors create successful and meaningful careers. Today’s topic is about the f 1 career transition, and I’m having a discussion with Wen Wang who researched this area. Now starting work is a very challenging time, and Wen tells me that many of the challenges revolve around uncertainty.

Of course, senior doctors can help new doctors successfully enter the world of work, and new doctors can themselves create change for themselves and for others. New doctors are the senior leaders of the future and can start influencing cultures right from today.

Mat: Welcome, Wen. Tell me a little bit about yourself.

Wen: Thank you very much for having me here.

Uh, I’m a an associate professor in human resource management. All what I’m [00:01:00] doing is I use big data, try to find out a good, uh, workplace practice can bring the best of people, uh, so we can achieve goals together. K.

Mat: And that sort of sounds very relevant particularly to health care because at the moment, I know a lot of people, um, are facing challenges and the whole system is facing challenges. And I invited you specifically to talk about career transitions and sort of in that that challenging period from going from a student into f 1 and f 2.

What what do we know about the transition that happens in those early foundation years?

Wen: Yeah. This is a project we have been doing, uh, since the last, uh, a few years. Um, you you you are right. Uh, health professionals are a self selected group with purpose and meanings, and we found the experience specific challenge and we, uh, [00:02:00] encapsulated into uncertainty.

When when, uh, postgraduate medical students go to become first employed professionals. In the UK, we have this, uh, national coordinating training system. It’s a good system. Uh, within 2 years, these doctors rotate every 4 months so they have a taste of different specialties. The idea is the more specialties you were exposed, it can help them to decide which specialty, uh, to pursue later on after 2 years.

But in the process, uh, it means a lot of uncertainty they experience because every 4 months, uh, rotate. They have to get into new work relationship and a new system [00:03:00] even to get to remember the new passcode, which is quite a challenge and for some have to change, uh, places, so there are new travel routines. But there is 1 thing which is really, uh, put this group in a very precarious employment position. Uh, we I we consider. So from research, we found, uh, they are in a triangular employment relations.

They were paid by Health Education England, now merged with, uh, NHS England. So HEE pay their, um, phase to get a print. Sorry. Mhmm. Uh, but they were directed to work for the nation’s trust And even complicated, we have the lead NHS trust have foundation, [00:04:00] uh, have these 20 doctors, and they were load to other trust.

Mhmm. So when the foundation year doctor, uh, need to progress, they were appraised by their director employer. And h a HEE is far away. Didn’t know what’s going on on the ground. That’s why doctor were bullied and, uh, harassed for a lot of the issues they experienced because they are in a very precarious employment position.

They can’t really voice their concern. Some of the doctor we interviewed, they they very clever people as we all know, and they just told me the trust has no incentive to voice for us because after 4 months, we’ll move to next, uh, specialty. So this make, uh, foundation year doctor’s employment condition is is not good. We we sort of understand their frustration.

Mat: [00:05:00] Mhmm.

I’m I’m interested in how how are things different outside of medicine?

Wen: As a HR professionals um, or researchers, we always emphasis on the director, uh, improve relations and commitment. But the the modern society has breakdown this, uh, team. In NHS, we know there are a lot of aftersourcing. You know, you have this locum doctor and consultant.

So the team cohesion was broken, And the the 20 doctors need to learn from a supportive team. But you you get this temporary doctor on temporary contract. It’s very difficult for them to cope with. So 1 1 thing we we want to to call for NHS [00:06:00] policymakers is to commit it to people because all the system, all the, uh, service provided people when we commission people, it will help people have peace of mind and to raise their concern of patients, you know, unsafe practice. Then they can deliver the high quality patient’s care we all, uh, aspire to.

Mhmm.

Mat: Mhmm. Um, you started off by saying that that that health care professionals, that that we are a, um, we’re a self selected group and you talked about, you know, purpose and meaning. And and how how how does that purpose and meaning what does that mean sort of in terms of our career? How does the fact that there is purpose and there is meaning, how does that influence our relationships with our careers?

Wen: Um, that’s a good 1. The health professionals, uh, especially [00:07:00] doctors, uh, the group I focus on, they are very intelligent people, you know, who can become doctors. And they choose this profession because they want to help people. Because health is just a fundamental, um, element for happiness, for quality of life. That’s 1 thing which, to some extent, become, um, a handle for their progress.

This is what I I talked to some of the policy makers. I said, um, when I learn the hardship our trainee doctors experience and also, you know, the high suicidal rates happened in the trainee doctors, We all feel shaken, you know, such a good group of people. How how could we put them put them in such a state? And this is what they told me. It’s because you, your lecturers, always [00:08:00] tell them they are the clever people, but they didn’t realize you’re just, uh, 1 of the persons to to provide health service.

I I think about yeah. There’s some, um, um, some elements, uh, is right. That’s why we are doing the research. If I I if we lectures made a mistake, we got to do something right. So I think 1 thing which we found in research is we need to keep reminding our doctors what is the purpose of your job because we all come here to serve patients.

And patients care bring us here. If we bear this in mind, you wouldn’t mind, uh, to create it, you know, um, this equal and supportive environment for your colleagues. And, uh, you you know, we need to work as a team. It’s not you work as a [00:09:00] doctor’s team and there is a nurse’s team. We actually need to work together because the purpose for us here is to provide the best patient’s care.

So I thought that’s quite important for their transition. That’s the first 1. What we, uh, we researched, uh, the first project survey, we received 323 responses from training doctors, and we interviewed 23 training doctors. Those people who have a better transition and learn more and have a positive, uh, perspective because they quickly learn we are here to serve patients. It doesn’t matter.

I can make a cup of tea for for for nurse and for my colleagues because I know they will look after me. So that that’s the first lesson. Uh, and second, we want to see for training doctors, um, especially foundation year doctors. Even you are [00:10:00] the most junior in the group, but you are the future. You are the leader.

Mhmm. So you can set the, um, the care standard, and you have the confidence to say, hi. My name is James. You know, you can set the call and set the standard because, clinically, you are the leader. Mhmm.

And demonstrate the professionalism. When we talk to, um, a lot of frontline managers, they found it’s very difficult to reach trainee doctors. They use all sorts of personal WhatsApp, personal phone numbers. They couldn’t get ahold of trainee doctors. So we need to demonstrate professionally professionalism and let them know you are there to provide patients care and always keep the promise.

Uh, 1 of the doctor, and she went to the extreme, and she said, I just tell my team. Uh, I [00:11:00] never say no to them. Whatever you ask them, I tell tell them, if I can’t do it now, I explain why, and I then I explain what time I will be there. I thought it was a very good practice.

Mat: Absolutely.

Um, I like this idea that, you know, somebody who’s a foundation doctor today, they’re gonna be they’re gonna be the future. And I’m interested in can you can you tell me a little bit more about, you know, what what how can a foundation doctor behave? What can they do to to act like a leader, to be a leader, and to to influence their environment around them? Because I completely agree with you. They have they have the power to influence.

Um, lots of people don’t feel like that. Yes. So people say, oh, I’m just foundation doctor. I can’t do anything. I disagree with that.

I completely agree with you that a foundation doctor, they have a a huge amount of influence onto the world around them. So what what can people do with that influence? [00:12:00]

Wen: Thank you. Um, I think those doctors are the fresh air into the fresh blood into the system. And in theory, we, lecturers, always teach them the most, uh, forefront knowledge, not just technique, also the progress of society, of human being.

Uh, for example, the inclusivity and, um, how to treat patients with all the things we learn. And all these, they can put into good practice. For example, foundation year doctor told me, um, when she talked to the patients, the patients would would like to be referred as a she because he has changed the gender, and she followed this rule when she changed over to a consultant and she give all this [00:13:00] information to the consultant that the patients rather would would like to be addressed as a she, and we need to bear this in mind. I thought that’s brilliant. Um, and also they have this, uh, equality.

They understand the purpose here is to serve, uh, patients. And 1 of the doctor told me, all the people know I’m Gemma. No no no person will know I’m doctor blah blah because I I remember everyone’s name. I know even the porter, even the, you know, any domestic staff. We all address each other and by name, and we support each other.

Um, so we started a very good day to check check on each other. How are you? How do you feel? I thought of this all brilliant. You know, with each little person, you’re like a planet.

You know, you radiate your energy, your positivity. So which you set the tone at the positive environment you’re going [00:14:00] to set. And 1 of the doctor told me, uh, uh, the consultant said, oh, I don’t need to remember your name because you’re going to leave in 2 weeks, but you need to have the confidence that, no. My name is Gemma. I want you to know.

You know? You you you you demonstrate as a new generation and a new leader, and we want to be inclusive. We want to include everyone and to to provide the service together. Yeah. Yeah.

I think there are some, um, cultures. It’s it’s deep rooted. But if we all demonstrate the positivity, it’s like, uh, the wheel. You know? Every every 7 times, you get a big 1.

So we keep pushing. We keep pushing that we could make the the environment better. Yeah.

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Wen: And

Mat: I I think it it it’s interesting because I would I would also say that that, you know, the foundation doctors have the potential to influence and change much more senior doctors.

Yeah? Um, and, you know, and and vice versa. Yeah. So so you know how how a senior doctor behaves, that that’ll change how the foundation doctor is, but also it works the other way around. So how foundation doctors behave that that that influences senior doctors.

And, you know, there might be sort of some senior doctors that are very set in their ways, probably not that many of us, because I think most of us probably are open minded. Maybe some of us lack the skills and maybe we lack the knowledge or we like the attitude, but it’s not it’s not because [00:16:00] it’s not because maybe some of the senior doctors, it’s not that we’re bad people, it’s just that we still got entrenched in our ways, We got used to stuff. And, actually, it’s quite welcome sort of to have somebody who has a refreshingly different way of doing stuff with a totally different perspective. I’m not saying that that’ll always land well, but often if you are a Foundation doctor that does come with a different perspective, with a different way of doing stuff, I I would like to think that that would be welcome. Yeah.

Um, I hope it would be welcome. Yeah.

Wen: Definitely. Because there is joy at work. Yeah.

You know, we we all feel, uh, achieve something by working together. It’s also great. We work, uh, at with different age group because we all learn from each other. And, uh, like, I learned from my students how to use, uh, this train power to save money by booking train. You know, we all learn from each other.

And you see young [00:17:00] trainee doctors know a lot of these, uh, tricks and the tips of social media. It’s good for them to learn together and to learn different perspectives. And, also, um, many consultants have their daughters’ sons become training doctors. So they they would like their children was treated with, you know, the way. Yeah.

I I think they they they all very, um, embracing these ideas. I work with 17 NHS trusts. I talked to 8 NHS trust leaders about the research finding. And some of the DMEs, they really take on the suggestion we made. For example, uh, we said trainee doctors really appreciate the opportunity to interact with senior doctors.

And 1 of the DMEs, the director of medical education, told me, and he set up a mentor [00:18:00] program because he from the recommendation, and he want to offer the opportunity to interact with the trainee doctors. And he sent the email twice, and he was waiting there 2 weeks twice. No 1 turned up. So that’s the other thing I want to tell trainee doctors. They are really good consultants, and they really want to to have, uh, 20 doctors.

So please take up all the initiatives and all the new ideas because we all want to try. We all want to somehow compare others to better the Yeah. The course we all serve for. I mean, all the consultants. The so that’s the other thing I want to see and engage with new initiatives.

Um, some of the, uh, trusts are not very good to communicate the things they heard from training doctors and they acted upon, for example, the parking [00:19:00] issues. As they addressed, but they didn’t understand the, uh, newsletters to see that that’s something we recommend the leaders to do and to show you really appreciate, um, the suggestion made by 20 doctors.

Mat: Yeah. I I can relate sort of to that of putting something on and nobody turned up because, you know, I’ve certainly been in that position where where I where I’ve done stuff for other people’s benefits, um, and it and it wasn’t taken up. And and, you know, I guess, sort of, for me, it’s fine because I say, well, okay.

They’re not interested. So so what? Um, I’ll I’ll move on. It is a bit disheartening because because I guess, you know, if there’s a bunch of us that are putting things on to try and make the world better and there is no uptake, then people stop doing it, don’t they? Um, so so this perhaps there’s a I don’t know.

It feels like from what you’re saying, there’s there’s a there’s an obligation for maybe the senior doctors. We have an obligation to support others, um, and to put on things that support others. But that [00:20:00] again is a 2 way process because the early career doctors, they have an obligation to turn up, um, because, you know, because if they don’t, then I’m simply gonna stop doing it. Yeah. Because, you know, that’s for those of us that are there to make the world a better place, we need we need to feel that we’re making the world a better place.

Yeah? Again, because, you know, if you sort of say, well, you know, I’m not making the world a better place. They’re not gonna do something else. Thank you. I’m busy enough.

Yeah. So I quite like that sort of fact that that there’s actually a 2 way 2 way street here as to how people influence and and help each other. And I really like sort of, you know, the idea of what people can do as frontline doctors, um, because because, you know, again, often if you are a senior doctor, you don’t know what happens on the ward. You don’t know the ward nurses. You might know the people in clinic or in theater.

In my case, I probably don’t know the the ward nurses that much because I don’t spend that much time there. And, you know, and I spent very limited amount of time with the patients because, you know, the people that spend more time with them are the people that are doing the bedsheets, the [00:21:00] people serving them food, and the people that are looking at drug charts and doing the clocking and the cannulas because they spend far more time with the patients than than I do. So so in that that kind of that’s really, really useful. And, you know, and those roles for me, you know, what as I said, whether it is the person that serves the food or the person that changed the beds, you know, or whatever whatever sort of role an f 1 or f 2 might do. You know, that that’s really crucial information that actually as a consultant, I have no access to that information.

Wen: That’s right. Yeah. Yeah. Definitely. Uh, I feel like if we work as a team, some of the information patients probably told people serving their food or nurses Yeah.

Which probably crucial, and they probably didn’t think of it when doctor come to see them. But if we work as a team, you know, all the colleagues would share those crucial information with doctors. It can help a lot. And, also, um, we have to, uh, [00:22:00] to recognize our trainee doctors’ body, you know, the body of the workforce become diverse as well. When when we look at our survey, you know, we have almost half doctors, 20 doctors, uh, are the first generation from the family into medicine.

Because if you if you are in medicine, we in research, we we consider there some, um, cultural capital, because you you would hear from if if you are from a medicine family, you would hear things going on in the world and, you know, all sorts of things. Like, 1 of the, uh, consultant I met, and his granddad was a doctor in 18 71. You can see the medical tradition in the family. And he he talked about him as a doctor because he [00:23:00] seems very happy and a very a very happy person And I really enjoy his work and really enjoy talking to, uh, trained doctors. So I asked him the secret, and he said, in our profession, you have to learn to be self caring.

Like, uh, they all in sports. So it take your mind off. And 1 of the DMU told me, he only take 2 days off for the last 30 years. That requires dedication and a good sports. And he said, if you know you’re going to have night shift, you you you better bring your nighties with you, have some healthy snacks, and book a room so you’re going to stay there.

You gotta look after yourself, um, not not driving home and after night shift because that will be more likely to have accidents. I thought that that’s so important because those are problem from the medical family, the the culture capital, and and they know if 20 doctors [00:24:00] come to the sessions offered by consultant, you know, including yourself. And since little things you talk, it will really expand, um, the things they they they be. They they wouldn’t from their own social circle. So that’s that’s why it’s very important for training doctors to pick up all the initiative, especially to have opportunities to mix the way as a senior, uh, consultant, uh, to learn, you know, the little things which actually can enlighten you a lot.

Mhmm.

Mat: Mhmm. And in in fact, this morning, I was talking to medical students and we were talking about leadership and and we talked about servant leadership as as 1 of the leadership models. Um, and we talked about this idea of of putting other needs before yours. And and, you know, my view on that is, well, that’s all very well, but how long can you put other people’s needs before yours?

Because, you know, you might be able to put other people’s needs before [00:25:00] yours, you know, for a shift, a couple of shifts, you know, maybe, I don’t know, maybe a couple of years. But if you’re gonna work for 50 years, you’re you’re not gonna be able to sustain working for 50 years if you’re always putting other people’s needs, um, be before yours. And and I suppose it depends on what we mean by needs. As you were talking about, am I putting other people’s other people’s careers before my personal career progression, you know, money, titles, whatever, then, you know, yes. That’s 1 thing.

But if I’m not sleeping, if I’m driving home tired, you know, I’m exhausted, I’m not looking after myself, you know, I’m overweight and unhealthy, then I I I won’t have a 50 year long career where I’m gonna be in a good position to to to serve others. Yeah. So in order in order to serve others, you need to be in a good place yourself.

Wen: Definitely. Definitely.

To sustain to sustain yourself, to be able to to to serve others. And if they if there are issues, [00:26:00] always put pressure on 20 doctors. So the system was made by people. We have to raise these issues. Uh, and also the other thing which I found a training doctor can benefit a lot from, uh, the opportunity to engage with seniors and registrars is when as a foundation year doctor, there are always so many tasks you can do within your shift, and you don’t really know, um, which 1 to prioritize because priority prioritizing task is so important for, uh, the overstretched system to work.

So 1 thing they can do is they can go to ask a registrar or ask a a seniors when they have the opportunity. See, I have so many I have this task. Which 1 do you think I can keep it tomorrow? That’s the skills. Um, so this all needed to mix with people as senior than you.

And then even nurses, you know, because they spend so [00:27:00] much time with, uh, with patients. They know a lot more information of the patients. They can help you to make decisions.

Mat: Yeah. Yeah.

What what else does, um, research say about career transitions and specifically that foundation doctor level transition?

Wen: Uh, right. So we come to always think about the purpose of the work, self caring, uh, being professional, bringing professionalism into the workplace, and demonstrate your leadership as a future. Um, also engage with new in new initiatives. To take up all the, um, idea the opportunities to meet with the senior people and to to talk.

We actually I summarize into, um, 3 r’s. The 3 r’s is for the leader. That’s I think it’s, um, [00:28:00] probably some is relevant for, uh, kidney doctors. Yeah. Right.

So, yeah, I put it there. 1 is ask leaders to be responsiveness, you know, especially senior leaders like CEOs, MDs, and DMEs, and consultant, um, to offer this opportunity for TriniDoc have direct voice because of this national coordinated system. Sometimes their needs fell through the cracks. For example, they didn’t get paid 4 months and the parking space and their study space. So this has to be addressed at the the trust level.

So we want to train the doctor to take advantage of the opportunity to offer to interact with senior management teams and to know [00:29:00] their place, HRs, and to raise these issues. Because if you if you don’t see, how could other people know? And and secondly, we talk about relationship. And just always reflect on the purpose of the work is to provide the best patient sir patient care. Mhmm.

Therefore, you know, build a positive relationship and set up the tower as a leader. And, uh, you know, my name is Gemma. And what’s your name? To know all your team members’ name, address each other by name, even the porter and even all the colleagues. Mhmm.

And we we also talk with other other recognition. So we want to train your doctor recognize you are a learner, so don’t be afraid to ask a question. Anything if you are not, uh, you’re not sure. Just ask. No one’s gonna laugh at you.

You’re just going to become a best doctor. People would admire your spirit to learn because that’s [00:30:00] why you are here. Uh, what else would you like? Uh, we also want to I want to train a doctor always bearing the mind. You are the future leaders.

So recognize the leading role that you you will take in the future. That’s why you need to learn learn from everyone. Therefore, you can lead better in the future. Mhmm.

Mat: I like that.

And maybe I’ll bring us to a close, Wenn, and perhaps if I could just ask you to maybe summarize what we talked about or, you know, what will be your top tips for doctors at work?

Wen: Right. Doctor are very admire, uh, admirable profession, and you have a lot of respect from a lot of people, including myself. I I show my respect by doing research to better your employment [00:31:00] transition. And if I summarize in 1 word, you are the future leader.

So you can set you can create the system and the workplace you would like to work with. Be approachable, supportive, and be kind, and also be professional. Learn from everyone and with competence to lead.

Mat: Yeah. That’s wonderful.

I like that. So the future starts today.