1. SAS Tutors Development Katharine Hankins, Senior Careers Adviser, London Emad George, NACT UK Council rep for East of England & Associate Dean Charles Cooper, Associate Dean, East Midlands Deanery Liz Spencer, Clinical Tutor, Education Adviser, NACT UK 4 October 2013

2. Objectives Clarify role of SAS tutor in careers support Know what resources are available Apply structure to a career conversation Motivate the disinterested And what else………?

3. In pairs discuss 1 A career decision that worked out well and how you approached it 2 A difficult career decision or one that didn’t work out well, and how you approached it.

4. What is career management? –What career management is? –What the service expects from you? –What do YOU want for YOU?

5. What is a Career? “The sequence of a person’s life and work experiences over time” ™

6. Modernising Medical Careers Definition Career Management: A proactive process to career development, career exploration, career decision making and personal learning which may be facilitated by a range of processes and activities ™

7. Definitions Career Information- Factual –Qualifications and experience required –Competition, posts available Career Advice and guidance-Clarification of information and personal –Trainee wishes to have help in deciding upon specialty choice –Needs to be impartial Career Counselling – Qualified counsellor –Those wishing to evaluate position often with a view to change

8. Changing NHS Consider in groupsConsider in groups –What makes you uncertain about giving career advice? –What is changing in the workplace? –How does this impact on you and your professional development?

9. Old ways of working Expert in one areaExpert in one area Limited changeLimited change Clear career path – one employerClear career path – one employer Regular promotion (up the ladder)Regular promotion (up the ladder) Organisation looks after its ownOrganisation looks after its own Rewards for attendance & years of serviceRewards for attendance & years of service New ways of working ‘Portfolio’ workers‘Portfolio’ workers Rapid changeRapid change Fixed term contracts – different employersFixed term contracts – different employers Career climbing frameCareer climbing frame Manage your career as if it were a businessManage your career as if it were a business Rewards for initiative & performanceRewards for initiative & performance Old/New Paradigm

10. Old ways of working Stress from being stuck in a systemStress from being stuck in a system Defined areas of responsibilityDefined areas of responsibility Less accountability in Public ServiceLess accountability in Public Service Dr knows bestDr knows best NHS had pot of money to spend as it wishedNHS had pot of money to spend as it wished New ways of working Stress from increased pace of workStress from increased pace of work Team responsibilityTeam responsibility Commercial/Business models in Public ServiceCommercial/Business models in Public Service Expert patient & spreading of expertiseExpert patient & spreading of expertise Ring-fencing, targets etc.Ring-fencing, targets etc. Old/New Paradigm

12. Career Conversation Stage 1- Self Assessment Help them learn more about themselves –Assessments, feedback, self awareness exercises What they what from their career Options to explore Stage 2- Career Exploration Awareness of resources available Provide contacts

13. Essential Resources Websites: www.medicalcareers.nhs.uk www.mmc.nhs.uk www.careers.bmj.com/careers/advice/advice- overview.html Deanery/Royal Colleges websites

14. Stage 3- Decision making –R –ealistic –O-ptions/opportunities –A-nchors –D-evelopment –S-tressors Stage 4 - Plan implementation –CV writing –Application writing –Interview techniques Career Conversation

15. Developing people for health and healthcare working on behalf of Your Role in Supporting SAS to Manage their Careers Katharine Hankins

16. working on behalf of Developing people for health and healthcare What did they find out about their aspirations? Associate Specialists 1/3 wished to become consultants via article 14/11 CESR/CEGPR Over half wished to remain on SAS grades Staff Grades Approximately 3/10 wished to become consultants via article 14 /CESR Over 1/3 wished to re-grade as associate specialists > interest in staff grades to become consultants than those on associate specialist grades

17. working on behalf of Developing people for health and healthcare What issues were uncovered? Unresolved career goals Feeling of being unsupported Difficulties in engaging in work & training opportunities Difficulties in re-entering training programmes

18. working on behalf of Developing people for health and healthcare What is top of their list? Top-up training for Article 14 or CESR; Time limited post/secondment for specific training opportunity or requirement; Management training; Specialist Clinic or theatre placement Post graduate qualifications

19. working on behalf of Developing people for health and healthcare Why do doctors need careers support? Research suggests: The need exists for more accurate careers information and advice. (Tooke, 2008) Quality and quantity of careers advice is sometimes inadequate. (Lambert et al.,2000;Jackson et al., 2003; Lambert and Goldacre, 2007)

20. working on behalf of Developing people for health and healthcare Effective Career Discussions at Work Wendy Hirsh, Charles Jackson Jenny Kidd NICEC 2001

21. working on behalf of Developing people for health and healthcare Careers support at its best - Careers support is most helpful when a shared framework is in place. (Hirsh et al., 2001; Kidd, 2006)

22. working on behalf of Developing people for health and healthcare The Parallel Clinical Decisions History Taking Examination/Investigations Differential Diagnosis Treatment Plan Career Decisions Self Assessment Career Exploration Decision Making Plan implementation

23. working on behalf of Developing people for health and healthcare Limits to the parallel 1.Clinically there may be only one correct diagnosis (although treatment options may differ) but career-wise – for most people there is probably more than one career option that would suit them. 2.Career planning DOES NOT equate with career pathology. Instead- the 4 stages apply to everyone, at all stages of one’s career. 3.Clinically – the doctor is responsible for the diagnosis. Responsibility for career decisions rests with the staff member.

24. working on behalf of Developing people for health and healthcare The cycle of career decision making Career Planning Self- assessm ent Career explorat- ion Decision making Plan Impleme- ntation

25. working on behalf of Developing people for health and healthcare Career Management 4 stage model Self-assessment Career Exploration Decision making - ROADS Plan Implementation

26. working on behalf of Developing people for health and healthcare How can this framework help you? Provides a systematic structure to the career planning conversations You can use it to help review and develop their career plans You may tempted to skip to stage 4 but it is important to review ALL the stages

27. working on behalf of Developing people for health and healthcare skills Interests Values Personality Influences Environmental Stage 1: Self –Assessment – what do you include? https://www.medicalcareers.nhs.uk/career_planning/self_assessment.aspx

28. working on behalf of Developing people for health and healthcare The power of the role model? Role Model Clinical knowledge ? Practical skills ? Personality Temper- ament ? Team leading Skills ? etc Think of Examples ?

29. working on behalf of Developing people for health and healthcare Stage 2: Career Options – what is available CESR/CEGPR - Consultant Gathering evidence Supervison/support Starting a new Specialty Depends on gap since training Credibility/commitment Competition with newer trainees Developing practice Maintains engagement Enables development of new skills eg new procedures, technological skills, adding responsibilities Capitalising on existing skills eg teaching mentoring, training Careers outside medicine Retraining/transfer of skills and knowledge Choice

30. working on behalf of Developing people for health and healthcare Stage 3: a Lifeline of decisions ‘..the best predictor of future behaviour is past behaviour…’ Take a piece of paper and lay it on the table in landscape form Draw a line in the middle of the paper across the full width Mark 0 on the left hand side and your current age on the right hand side Put a + above the line to mark positive decisions/experiences and – below the line to mark negative experiences/ decisions Now mark significant life events: experiences, achievements Mark on your lifeline the things that have worked out well and put them above the line. Leave space to add more as you think about them Now review the positive experiences: What made them good decisions? How did you go about making these particular decisions? In your own time you can think about the less positive experiences: What made them poorer decisions? How did you approach these decisions that didn’t work out so well?

31. working on behalf of Developing people for health and healthcare Stage 3: Are negative decisions/events always bad? 050 272629 34 48 7 Diagnosed with childhood RA Accepted for Cambridge Work in negative, unrealistic expectation of specialty – wrong area, wrong specialty Marry (Lifetime friend/support) Appointed as geriatric trainee – Good decision Post too busy – reduced support & pressure to organise research Appointed as consultant Deanery Post! + + + + - - - - Good decision Correct career choice Consultant timeline taken from The ROADS to success by Caroline Elton & Joan Reid

32. working on behalf of Developing people for health and healthcare Stage 4: Next steps ? Implementing the plan Compiling CVs Interview practise Developing networks Training awareness Opportunity awareness Portfolio advice

33. NACT UKCoaching Conversations Motivational Conversations Liz Spencer

34. NACT UKCoaching Conversations Workshop Objectives The components of a worthwhile meeting with a colleague The components of a worthwhile conversation Listening skills Engaging with a colleague’s agenda

35. NACT UKCoaching Conversations The components of an effective meeting with a colleague Preparation Engagement Listening Motivating

36. © your company name. All rights reserved.Title of your presentation Prepare How do you prepare for a conversation? How could you help your colleagues to prepare for their conversations with you? How should you prepare for your conversations with your colleagues? Prepare

37. NACT UKCoaching Conversations Engagement How might your behavior and conversational style inhibit an effective communication? How do you make sure that you and your colleague are working together in a conversation? Engage (Revenue/Growth)

38. NACT UKCoaching Conversations Motivation How might you influence your colleagues' motivation: Firstly, during a conversation with you? Secondly, following a conversation with you? Motivation

39. NACT UKCoaching Conversatuions Listen What does “Listening” mean in a conversation? Listen

40. NACT UKCoaching Conversations The components of an effective conversation (D Goleman) Mutual Attention Non-verbal synchrony Mutual Flow Trust

41. NACT UKCoaching Conversations Trust is the glue of life. It’s the most essential ingredient in effective communication. It’s the foundational principle that holds all relationships. Stephen R. Covey

42. NACT UKCoaching Conversations Gauging rapport in conversations: Focus Am I actively listening? Focus Am I actively listening? Empathy Does my colleague Know I’m listening? Empathy Does my colleague Know I’m listening? Connection Have I established shared common ground? Connection Have I established shared common ground? Empowerment Does my colleague feel liberated by chatting to me? Empowerment Does my colleague feel liberated by chatting to me?

43. Motivational Interviewing 43 http://www.motivationalinterview.org/quick_l inks/about_mi.html http://www.motivationalinterview.org/quick_l inks/about_mi.html

44. Motivational Interviewing Motivation to change is elicited from the client, and is not imposed from outside forces It is the client's task, not yours, to articulate & resolve their ambivalence Direct persuasion is not an effective method for resolving ambivalence The style is generally quiet and elicits information from the client Your job is to help the client to examine and resolve ambivalence Readiness to change is not a trait of the client, but a fluctuating result of interpersonal interaction The therapeutic relationship resembles a partnership or companionship 44

45. ELICIT PROVIDE ELICIT 45

46. What skills do you have that you are proud of? Tell us about the things you do well. Tell us about the things that are good about your job What is good about work & non-work activities – interpersonal & personal skills. How safe do you feel? What resources are available to you to develop yourself/get further education? Who do you have relationships with that are pleasing to you? Who would you go to talk to when you needed to talk about something important? Who helps you out when you need it? Think about all your moods. – Which moods do you have that are good? – Describe how well you handle moods which are not so good? Think about your values, sense of belonging, goals, religion, beliefs. What do you see as your strengths? What would you like to do more of? How could you influence that What else is good? What else are you good at? 46 ELICIT

47. Provide information in a neutral, nonjudgmental fashion. What are you going to say? 47 PROVIDE

48. The doctor’s interpretation What does this mean to you? How can I help?” vs. “It’s obvious from this information that you need to change.” 48 ELICIT

49. And Finally….. Rewarding Outcomes Are:

50. SAS doctors are…? 1. Focused & Realistic Know what opportunities to go for, clear on which sub specialty to pursue Have right skills, motivation and experience to achieve their goals 2. Unfocused & Realistic Unsure which subspecialty or opportunities would best suit them Sound objective awareness of their skills, knowledge and experience 3. Focused & Unrealistic Clear idea in mind (may even be too focused) Don’t feel they can demonstrate the relevant level and mix of skills, knowledge, motivation and experience to make it achievable 4. Unfocused & Unrealistic Not sure what they have to offer and / or what they want to do Surface level knowledge of what opportunities would best suit them and what opportunities may be out there

51. Approach to Unrealistic Doctor Use 4-stage approach –What does this doctor see as their key strengths and what evidence is there for this? –Which areas have they been judged to be less strong? –Do their skills and weaknesses match the skills required for a consultant position? –Have they reviewed the person specification? –Are they aware of the competition and how competetive they consider themselves?

52. Pose challenging questions Do not tell them they are not suited to their career choice: through discussion guide them. Suggest they speak to a consultant within the specialty REMEMBER: If they chose to ignore your feedback it is their decision. Approach to Unrealistic Doctor

53. Effective Discussions Setting up the Discussion –Preparation and setting the agenda Establishing Trust –Listen and support Sharing Information –Awareness – sensing: seeing, hearing, feeling, smelling & tasting –Appropriate non-judgemental questioning –Offer constructive feedback Agree action plan

54. Associate deans for SAS doctors Educational leadership Support for SAS tutors Support for SAS development in organisations with no medical education team (PCTs and their successor organisations) Overview and guidance on use of SAS development funding (and similar in devolved nations) –in multi-professional education and training (MPET) allocation from SHA –devolved to Trusts etc, or centralised

55. Key to success Change of mind-set Self-belief Resilience Persistence

56. SAS Doctors Be seen as credible & experienced clinicians Demonstrate passion & commitment to specialty & dept Become involved in audit, leadership & management issues Contribute to needs of dept – teaching, service improvement projects, supervision Make the dept WANT to support you

57. Thanks liz@doctorstraining.com www.doctorstraining.com