Thriving & Surviving As A First Year Consultant
“You never have a second chance to make a first impression.”
How you initially come across to your colleagues, the nurses and your patients as a newly appointed consultant can set the tone for your consultancy for the rest of your career. Once an opinion (winner or loser) has been formed about you, it is virtually set in stone. It is much too important to leave these things to chance. In your first year you will either sink, float or swim!
‘Thriving and Surviving as a new consultant’ [1] is a course by The Urology Foundation (TUF) specifically designed to help consultants at the start of their careers take control of situations and to become good leaders, colleagues and, most importantly, good medics. Good communication and presentation skills are vital to how others perceive and respond to you; fortunately these can be learned and developed. More importantly, leaders are not born, they can be made and it is possible to improve and hone your skills and attributes so that you can become a more confident and natural leader.
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Last weekend, a number of newly, or about to be appointed, consultants attended an interactive two-day course in Leeds where subjects such as team building and development were discussed. “The team” was considered to be the colleagues, managers, nurses and other healthcare professionals involved in the urological care of patients. We discussed and debated how we could create the “Manchester United” department of urology, delivering the best possible in patient treatment and care.
A new consultant shouldn’t try to change too much at first, but instead carefully assess and evaluate the lie of the land. Learning about the department, associated departments and the hospital itself takes time and trouble. It is good though to have at least five SMART (Specific, Measurable, Achievable, Realistic and Time-constrained) goals to be achieved within the first year of his or her appointment. But what should these be? Do let us know.
The medical defence organisations recognise that the first year of a consultant’s career is one of exceptionally high risk for complaints and litigation. We focused therefore on avoiding pitfalls, dealing with complications, and responding to complaints and serious untoward incidents (SUOs).
Navigating your way though the dangerous waters of your first year as a consultant can be a very tricky business. We would love to hear about your experiences in that situation, or, if you attended the course, what you thought of it and how we could do it better.
Roger Kirby, The Prostate Centre, London
Louise de Winter, Chief Executive, The Urology Foundation
[1] The course was made possible by an Educational Grant from Takeda UK Ltd. Takeda had no involvement in the content of organisation of the meeting.
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Congratulations on this great initiative to ease the challenging transition from resident to attending (or “registrar to consultant” in the Queen’s language). One specific tip if you are starting in a new department is to avoid constantly saying “at ___ (my previous institution), we did it this other way.” It can set a negative tone with members of your new department and often there are many different ways to skin a cat. Try to use differences in clinical pathways as an opportunity to broaden your horizons, or as motivation for future comparative studies on the best plan of care.
Stacey
You are so right. We have a catchphrase at guys “on my fellowship we did it this way…” Nothing is designed to make other consultants more irritated!
It is said that you have 3 months before people make an impression about you. If your first interaction doesn’t go well it leads to a bad reputation and you have no idea how much people talk to each other in your dept when you start.
Once a bad impression has been formed it is very difficult to turn it around. This course is a great way to prepare for the new consultant life.
Roger, this is a fantastic idea and something that we should be doing in Australia as well! Ben and Stacy, totally agree with your comments. In a similar way, the local urology community often rolls their eyes when new consultants repeatedly make these types of statements and especially when they don’t end even years afterwards – I thinks its okay to make the odd useful comment about other perspectives but when it becomes like a broken record…… (for our much younger urologists & trainees, records are the things that music used to be played on before CDs and MP3s and when scratched, plays a repeated loop that sounds like rap music).
Absolutely brilliant course. Would definitely recommend to all senior trainees approaching CCT. I have learnt a great deal including gaining insight into the trials and stresses of being a new consultant.
Stacy – You’re absolutely right. Sometimes it can be very tempting as a ‘newbie’ to go in and start shaking things up straight away. But that can be a golden ticket towards ‘losing friends and alienating people’! There is a fine line between brimming with ideas and a desire to improve and innovate and having the tact to wait for the optimum moment to suggest and introduce new ways of working. Part of the TUF course is about demonstrating listening and communication skills so that you build relationships and win friends and influence people around to your way of thinking.
Marc – Really pleased you felt you got a lot from the course. It was great to see you there!
Thanks to TUF for organising another intellectually stimulating course.It was great to bounce ideas off the faculty and fellow delegates. I have already started putting in to practice some of the techniques I learned over the 2 days. I don’t know of any similar courses for urologists taking these early steps into their consultant careers. 5 stars!
Thanks for a fantastic course, it is a must for all trainees close to their CCT. It was great to meet colleagues either at the same stage or just ahead in their career and hear their experiences, as well as being able to ask questions of the faculty.
Mary Garthwaite’s advice about “get the little things right” i.e. before trying to make major changes, implement new services etc will be one of the many insights I will keep in mind when I start the next phase of my career.
Thank you for a thought provoking and inciteful course. The 1:1 discussions and pearls from both faculty and new consultants make this course unique. Particular enjoyed the generation X talk and how this relates to future workforce needs and the importance of social media. Thank you TUF!
Thanks Olly
On a previous course I asked for a show of hands of those who found their first year as a consultant a stressful experience. Everyone raised a hand! On the current course I shared the tale of the overconfident new consultant who performed a difficult cystectomy as his first case. Predictably the outcome was poor and the patient was still on the ward one year later as a permanent indictment of his surgical skills! Take it easy in theatre when you first start a consultant job!
This is a great course and extremely useful for senior registrars and newly appointed consultants. It was very well organised, interactive and fun at the same time. I have learnt a lot of practical tips from the experts.
TUF have developed a unique course which is invaluable to those embarking on their consultant career. Having benefitted from the course myself over a year ago it was an absolute pleasure to support the course this year as a faculty member. The mix of consultant experience and professional leadership skills on offer makes for a dynamic and memorable event. It’s great to get such positive feedback and I’m delighted you all enjoyed it. Make sure you recommend it to those following in your footsteps!
Congratulations TUF on such a practical course. I am not aware of any other charity which tackles such an important gap in the life and knowledge of newly appointed urologists.
It was particularly good timing for me to attend this course, given I started my consultant post two days later!
The significance and difficulty of transition from senior trainee to consultant can easily be overlooked, both by trainees approaching the end of their ST7 year but also by their trainers. From personal experience, it’s all too easy to get wrapped up in the ST7 year with the competition to get a job for a trainee and the bureaucracy of completing training to think properly about the next step of your career.
Having attended the TUF Surviving and Thriving course, I would strongly suggest that anyone approaching their CCT attends this or a similar course as it gave a true perspective to the first few weeks and months of your new post, rather than the corporate induction, where do I get my car park pass, how do I get computer access issues which invariably preoccupy your thoughts prior to starting in post.
One of my learning objectives for the course was how to integrate into, and further strengthen, the teams that I’d be working in. These issues were covered extremely well (along with helpful suggestions such as buying a decent coffee machine, providing biscuits and organising kebab lunches! Indeed, I’m sat here in my new office looking at a large box of biscuits working out where I can fit a coffee machine).
The interaction with the faculty was also extremely beneficial, providing some really thought provoking insights and experiences from those who’ve been there recently and from those who’ve watched many people make the transition.
I’d strongly recommend this course to anyone in their final year of training, though I’d also strongly recommend is not pretending to be a tree in front of the President of BAUS, whilst he pretends to be a witch. Long, long story…………………………………..
Many thanks to all of those who made this excellent course possible!
Guys
Thanks to TUF for an excellent course. It was also a real pleasure to see familiar faces and old friends again. I hope the delegates that are new consultants can link up together occasionally and we can share our experiences of life as a new consultant. I am still in my first month and thus honeymooning, but I’m sure all the words of wisdom from the course will be hugely helpful as I try and navigate the next few months to years.
And Jeremy, you made an awesome tree.
PS ([email protected])
Thanks for the kind comments Ladies and Gentlemen. And readers don’t forget the SPRUCE interview training skills course run by The Urology Foundation (TUF) in the Spring. This is an excellent two day course aiming to hone your interview skills so that you get the very best Consultant post that is available. Details on the http://www.theurologyfoundation.org website.
Thanks for an excellent and thought provoking course. The pratical sessions were great and I could relate to some of the difficulties described by Mary and the other faculty, having just completed 7 months as a Consultant. I would certainly recommend it anyone just about to make the big leap and I just wish I had done it sooner!
I echo the thoughts of those who have beaten me to the blog!
I have benefitted from the brilliant SpRUCE and Thriving and Surviving courses run by TUF in my final year of training and now into Consultant practice.
The increasing emphasis placed on non-technical skills is accommodated brilliantly by TUF and the faculty. The opportunity to reflect on what is important is complemented by the opportunity to ask for specific tips from the experts.
Both courses have been promoted by SURG this year and I cannot recommend them enough to senior trainees (SpRUCE and T&S) and new Consultants (T&S).
Thanks again
Ben
The first consultant year is brilliant. You’ve made it!! Hopefully at an institution of your choice! It is however stressful indeed.
Roger Kirby highlighted the medico legal risks at this time which is no surprise as one is just starting to learn the trade. There is so much to learn about running a clinical service as a consultant as opposed to cherry picking as an SpR. The bucks stops with you. You have to deliver your product efficiently, effectively and safely.
As in windsurfing and skiing it is better to go slow and look good than fall over. My tips for year one would be to take it slow. Meticulous attention to clinical detail. Really look after your patients and be ALL OVER any problems and 99% will go away without consequence. As long as you wind your neck in and avoid too much peripheral activity in year one you have a lot of time to learn how to get the clinical aspect of the job correct. More time to focus than you have ever had before or will have again.
Would I cause upset if I came at this a little differently? In 1990 when I returned to Dublin after a 5 year Urology Residency and Fellowship In Baltimore, I naively thought I had been appropriately trained to take on being a Consultant (Attending in US parlance). In retrospect I was not, and I believe that was the same for my contemporaries whether or not they did their training in Ireland or the UK. What I lacked was training in Business, Administration, Finance, Interpersonal Skills, Human Resources and Practice Management. These are all necessary regardless of whether you end up in Public Practice, Private Practice or a Public/Private Mixed Practice. We would never hop on our own learning curve regarding the Practice of Urology……we would complete a training programme! How bizarre that we start independent practice with little or no Business training. We have to learn it all by trial and error as we go. Without formal Business training we are sitting ducks for those we interact with whether they be colleagues and staff in the work place, medical device companies, pharmaceutical companies, banks, insurance companies, pension providers or financial investment consultants. We sometimes get lucky and it all works out well and sometimes we get burned and either our hospital and our patients suffer the consequences or we alone suffer the consequences. It is my belief that a Business course should be part of our Medical School Curriculum with “top-up” courses later in our Residency and Fellowship training. In the US and in the British Isles, some medics do go on to do an MBA (Masters in Business Administration) and the changes this course brings about are palpable. Few of us are going pursue an MBA, but most of us would greatly benefit from some Business acumen. I think the TUF initiative is a great idea and one that may turn out to be a “game changer” in finally introducing Business Education into Medical and Postgraduate training. Why be so smart in our own surgical discipline and so dumb and naive in the ways of the world?
David, that’s really interesting. You’re right that the need to keep on learning and improving on all aspects of the job is an ongoing thing, and one training course isn’t going to see you right throughout the rest of one’s long and, hopefully, stellar career. There may indeed be a call for a business skills course at an intermediate stage in a consultant’s life.
On another note, it strikes me that our Irish colleagues are potentially missing out on this opportunity. Do you think there would be an appetite to run a Thriving & Surviving skills course in Ireland?
Thoroughly enjoyed the course. Would certainly recommend it to others.
David, that chimes with some of my own thoughts: UK trainees, when they get a CCT, are largely clinically competent. With mentoring and support their clinical practice will expand and mature and that will be a priority for everyone. What they do need to do is to determine what else they want to do. Do they want to become a manager, or a trainer, or an academic? Do they want to make as much money in private practice as possible? do they want a work life balance and a good gold handicap? Unfortunately not everyone can do everything, (probably no more than 2 or 3) and everyone needs to choose. One of the things that a new consultant can do is to decide what they do want to do, if they haven’t already done so, and to develop the groundwork for the future. That includes the training that David outlines.
The course was great, well facilitated and a nice mix of theory and practical: there was even a short break to watch the crucial tries as the Lion roared in Australia (sorry Henry). Oh, and we even won the tennis and the cricket! What a summer of sport!
Well done Roger and faculty and Louise and co at The Urology Foundation – these courses clearly very well received and addressing an unmet need. I particularly agree with David Quinlan’s comments – we need to become more business-aware when embarking on independent practice – I am sure TUF will rise to meet the challenge.
I recall Roger and a few of his mates (incl John Fitzpatrick) running similar courses for senior trainees/young consultants about ten years ago supported by pharma industry. These were aimed at UK and Irish trainees and always took place in nice cities (I recall attending in Dublin and Amsterdam). I reckon you would all enjoy a trip to Melbourne in December to run a similar course – more Ashes excitement beckons!!
Congratulations Roger and Louise: I don’t think one can have enough preperation and cautionary tales when starting out.
I would very much echo Louise and Declan C’s points about cautious beginnings. This is a 30 year career and the relationships you form take time to develop, so don’t expect to change things over night or go in two-footed (like a Paul Scholes tackle to continue the MUFC analogy).
It is sobering that litigation is so high initially. I suspect that this reflects a failure in Urology departments to adequately support and nurture junior colleagues, but also, perhaps, that in the midst of being exposed to the politics of consultant life, we can forget that the most important relationship in medicine is between us and our patients.
Interesting to read all the comments! I well remember the course given by Roger Kirby and myself, which Declan Murphy referred to. I think that after it my mind and I suspect Roger’s also went completely Sauvignon Blank!
It is a good idea for people to attend such courses, because as everyone finds out a bit too late, there is a huge and sudden gap between your last year in training and your first as a consultant. I’m not sure the emphasis should be totally placed on the business issues, however. I think that the more onconcentrates on how the patient feels about it all, the less trouble one will get into in one’s professional life.
Thanks for posting your comment on the blog, John. You are right about the Sauvignon Blank!
I also think that you are right about us not focussing too much on business issues, as we are not businessmen, first and foremost, but doctors. “Putting patients first” has become a clique, beloved of politicians, but it remains an important principle. In addition, we live in a world where litigation against doctors is rising exponentially, so being aware of pitfalls and knowing how to deal with complaints and complications is ever more important. We are currently planning our next “Thriving and Surviving” course for 2014. All last year trainees and first year consultants are welcome.
“How often does a fledgling consultant have the undivided attention of the BAUS President or other senior urological luminaries (self excluded) over a relaxed dinner and then experience these same very human individuals role playing or joining in mind games or baring their sole in relation to urological mishaps?”
So quoted one of the trainees in summarizing their experience of this course. All wonderful stuff but his primary take home messages were —- take the sisters and the staff to dinner regularly and nurture the team …. so very important in the current pressured NHS environment.
Giving trainees and new consultants courage and confidence in managing difficult situations is one of the hallmarks of this course and seeing those kernels of confidence taking root is really satisfying.
It is unbeatable as you embark on the consultant career —- Fight For A Place !!!
Thanks to TUF which continues to support many novel educational projects. This course is another brilliant initiative. TUF has supported the national simulation project by funding appointment of an Academic Clinical Lecturer. Urology is the first of the surgical specialties which has taken lead in getting simulation curriculum approved by the GMC. This course has been incorporated as part of the Non-Technical Skills training for ST7 trainees. Therefore it should now be considered mandatory.I hope this course will become an annual event (through sponsorship of TUF/Industry) in educational calendar of senior trainees before they get appointed to the important role of urological consultant.
Thanks for your kind remarks Shamim. We appreciate the work you are doing with simulation. TUF is focused on developing and extending it’s educational role not only for trainees but also for established consultants. There has probably never been a greater need for education in both clinical and non-clinical areas of urology. We plan to work in tandem with BAUS to help urologists in the UK develop and provide state-of-the-art care to all of their patients. Urologists can help us to help them by supporting The Urology Foundation.
As a previous participant and contributor to this course I can whole heartedly recommend it. It is a unique opportunity to gain the insight of very experienced and worldly wise colleagues and I certainly learned a lot myself.
A wise consultant once said to me, when I was a trainee, that your consultant colleagues in your work life are like a spouse. The main differences being that you may see them more frequently than your actually wife and the option of divorce is not as accessible.
Building any relationship takes time. It evolves with shared ideals and shared experiences whilst incorporating consideration of your colleagues needs, wishes and aspirations. A team approach with team thinking.
My advice to new consultants would be that as the new element to your departmental team, try to get the balance right between not upsetting the established order by trying to change too much too quickly, whilst maintaining your energy and enthusiasm to improve things.
Secret of any success is preparation, preparation and preparation. It starts right from the time one reads the advertisement for the consultant job application. Finding the needs of the department and whether you can satisfy those needs is crucial. Meeting the future colleagues and finding out the future directions of the department and how one fits into the existing team is the key. Once you are appointed by the colleagues then the real test begins! First year is testing times and bottom line is patient safety. Keeping your senior colleagues on your side while you are performing many procedures with your own responsibility for the first time is very important. It is also vital to have somebody as a mentor to help and guide you in difficult decisions.One can float new ideas with approval of colleagues and management. Once you have sailed through first year without annoying anybody, second year will give you more freedom to develop the department.
First year consultant job is the beginning of learning real life experience.
The course organised by TUF for senior trainees is a real eye opener as it is not part of the trainees curriculum.
It’s wonderful to see so many positive comments on this blog and to know that delegates on the recent ‘Thriving & Surviving as a New Consultant’ course thought it was really worthwhile and helpful. Just to let everyone know that TUF is planning on running another new consultant course next year – probably in the autumn – and that we are making plans for another SpRUCE course (how to become a consultant) for end February. So, if you haven’t been on these courses before, I strongly advise that you sign up for the next one! Watch our website: http://www.theurologyfoundation.org for info.