Becoming a Great Clinical Academic

I think there's definitely some truth in that. The difficulty with all of this — whenever you hear advice from anyone who's supposedly done okay in their field — is you've got this massive issue of survivorship bias. Just because it's recent: they're interviewing people after the Olympics who've won a gold medal, and they go, "Oh yeah, it shows that if you work really hard, you get what you want." Well, that's irrelevant if there are 10,000 other people who actually worked harder but didn't get what they wanted. What you really want to find is the differential. So if you took a thousand medical students and they all started having morning routines, and then at the end you saw how they did — however you define success — you might find these things make no difference, and that it's the people who are intrinsically more motivated who just find ways of doing them. So it's quite tricky.

Having said that, there is a real benefit — certainly for me personally — in having structure. This thing of having rules and principles makes your life so much easier. If you have a general rule, whether the rule itself is that helpful almost doesn't matter as much as the fact that you have one. You don't spend time worrying about a decision, because you go, "That's my rule. If I get an email and it's more than this, this is what I do with it." You save time and mental energy. And I'm not sure whether a large part of the benefit is just that it takes away the mental activity — because every morning you do whatever it is: exercise, meditation, mindfulness. That's a decision you're not making anymore, because it's a habit.

So I think there is truth in it. And I'd always urge everyone to be really cautious about people who go, "Oh, I did this and this and that, and that's what allowed me to achieve whatever." As a general rule, I genuinely believe that even in medicine, about 50% of whether you succeed — and I use that term in the broadest sense, meaning whatever you personally want to achieve — is down to all of these things we might talk about, but about 50% is luck. Luck meaning things you have no control over: what specialty you decided to go into, what happens in the future. No one could have predicted COVID. If you'd been a coronavirus researcher four years ago, you'd have got no funding — people would have said this is mad, these don't cause any diseases, it's a waste of time. Now you'd be the hero of the world, because that was a very niche area. And you couldn't have predicted that.

Anyone who says they succeeded just because of what they did is kidding themselves. There's a massive amount of luck — who supported you, where you were, who you happened to be working with in your junior jobs, who inspired you. But similarly, there are things you can do to make your life easier and maximise your chances. And that's what we're talking about when we talk about effectiveness.

I know it's not very trendy at the moment — it's a bit dinosaur to say you still use email. But I've tried all sorts of approaches, and for various projects I've used Slack, Trello, Teams, all sorts. I've yet to find anything that comes anywhere close to email for actually managing my life. The reason is that if you work for one organisation with multiple projects, things like Slack work really well. But if you're working for multiple organisations — a couple of hospitals, a university, things outside — having all these platforms is quite disruptive and hard to manage for your time.

I've unequivocally found email works best, just because you can set up rules and filters and move things into folders. I have folders for what I'm going to do on the train, what I'll do at work, what I'll do when I'm doing academic stuff. And I'm really strict with it. I don't get a massive number of emails — maybe 150 or 200 a day, of which 50 are just nonsense you can get rid of quickly. The others I absolutely deal with. So, unless I'm on holiday, at any time there will be no unread emails in my inbox. Three or four times a day I'll go through and filter them by what I need to do. Email works so well for me because I can do things asynchronously — I can fit in what I need to do in the time that suits me best. That's what's most efficient about it.

The rule I basically have is that every single email, I either delete it, deal with it immediately, or put it in a tagged folder so I know when I'm going to deal with it. The other thing that's really helped is being able to send things to read later — I use GoodNotes on the iPad. That saves me a huge amount of time, because if there's a PDF or a document I need to read, I can just push it there, knowing I'll read it on the train or at some other point.

And it's not just email — even in your clinical work there are rules you can set up for when and how you deal with things. In my clinical role I'm a diagnostic histopathologist, and I've learned over time that certain specimens — renal biopsies, say — need a bit of thought and time, where you need to be fairly alert when you're reporting them, whereas others are much more run-of-the-mill and you can report without quite so much concentration. So now I can triage things as they come in: what do I need to do this morning, what can be done later in the day when I'm tired? There are all sorts of rules you can put in to make your day much easier.

The things that don't work are anything extremely vague, or someone trying to tell me about a topic I've been working in for 30 years. Sometimes people send an email going, "Oh, the placenta is really important," and you think, don't start off like that. If you want to stand out, the first thing is to be very specific, be very polite, and show you've made a little bit of effort.

For example, under no circumstances will I ever respond to anyone who can't even be bothered to get my name or my title right. That immediately gets deleted, regardless of what else is in it — it's an immediate filter rule I have. If you can't be bothered to sort that out, I can't be bothered to read your email. Most people I know will respond, but don't put something vague in the subject line like "Hello." It has to be something really specific and relevant to that person.

Yeah — and it's not that you're trying to be mean. It's just that you end up getting a lot of these, saying, "Oh, I'm really interested in this area, can I speak to you?" It's not that you don't want to speak to those people, but to me it shows a laziness. That's saying, "I'm interested in this thing, I want you to help me, and I'm not giving you anything — any reason why you should do this." Whereas if someone writes, "I'm really interested in paediatric pathology, I'd like to get in touch. I've done this and this, I've read this and this, and I have some specific questions based on what I've read. I hope you don't mind me contacting you" — then you think, this person's a bit switched on. They've put in the effort, they've done the work. And often people will respond to that. But just a lazy "Can you help me out?" is basically begging, and that's not going to get a good response from anyone.

One of the most useful skills I've found is learning to be politely annoying, and escalating that as time passes. So if you and I were going to do something, and you'd agreed that by next Friday you'll send me something, then next Friday, if I haven't got anything, I'll send you an email. The first one is: "Hope all is okay — you said you'd do this, do get in touch." If I still don't hear anything by Tuesday or Wednesday, I'm sending another, and I'll persist. I'll track you down, and you'll be harassed until you do this thing — but in a really polite way.

I've found that for working in the NHS, that's a meta-skill you need. If you don't have it, you can't do anything. There's nothing that annoys me more than someone who, when I ask them to sort something out, says, "Oh, I'm waiting for so-and-so to reply, I emailed them." I didn't ask you to email them; I asked you to sort out the thing. You sending an email is irrelevant — the thing still hasn't been sorted. As you'll learn working in the NHS, things go into piles on people's desks, and you need to get your thing near the top.

That's a bit different, though. I wouldn't do that if I was inviting someone I didn't know to be a co-author on a paper. If they didn't respond, I'd do one polite follow-up, just to make sure they hadn't lost the email, and if they still didn't respond, that's the end of it. But once you've responded and agreed to do something, that's it — now you should be doing it.

It massively helps to have rules and principles you're going to live by. And I absolutely don't buy this idea — in any scenario — where everyone says, "Oh, we do everything on a case-by-case basis." That's a massive cop-out, and it's not true. When you do something on a case-by-case basis, what are you doing it against? You're not doing the whole case from scratch every single time — you have some rules. So "case by case" is just nonsense. You need rules when you're looking at a renal biopsy, you need rules when you're seeing a patient coming into A&E, you need rules for how you're going to do things. And sitting down and consciously making some decisions about those rules will make your life dramatically easier.

To give you an example: when I started training in pathology, I had no background at all in renal medicine. And as any medical student or junior doctor will know, if you try reading a renal pathology textbook, it's almost incomprehensible to start with, because everyone goes down into detail without giving you the overview — a nice, simple decision tree, which is basically what you want. So I spent a lot of time working out for myself: what's the decision tree, what are the things I need to do for each? You can do this for tumours, for all sorts of things. And oh my God, it suddenly made my life dramatically easier. You realise that a lot of the difficult, complex things aren't actually that difficult and complex — they're just made difficult and complex, because everyone likes thinking they're really clever and that it's hard. But in fact most of these things can be broken down quite simply.

So the first bit of advice is: have clear rules about how you're going to deal with these different scenarios. The second thing — and we touched on this last time, but it's super important — is to separate the outcome from the decision-making process. The fact that something didn't go the way you wanted doesn't mean the other option was a better one. You might make one decision where there's a one-in-two chance of a bad outcome, and another where there's a one-in-ten chance. You do the one-in-ten, and the outcome is bad. It's still the right decision — it just happened that the outcome wasn't what you wanted. If you're interested in that, there's a great book that talks all about it: Thinking in Bets, which is all about how to have that process.

As you said, the book could be summarised in one or two sentences, but the message is quite important. It's primarily about this: whenever you're making a decision about what you're going to do, are you thinking about it in the medium to long term, or just in the short term? Wherever possible you want a decision that maximises both, but where you can't, in almost all circumstances the long-term decision is the better one — that's always the one you should pick.

Take the clinical academic in medicine. What you want is a long career. You want to establish yourself as a clinician and as an academic, and to do that you're going to need other people to support you, and you're going to have to do it on a consistent basis. You're not going to be a clinical academic if you write four papers next year and then nothing for five years. It's about consistency — building things so that in five years' time you're in a much stronger position than you are now. It's always the long game. That's true of how you choose who you're going to work with, too. Just accept that some of the time you're going to get screwed over a bit by people. That's okay — don't do it again, learn from it. But what you'll gradually find is that over time you align yourself with more and more of the people who are good, who'll support you and help you. And that becomes like compound interest, because you're getting more and more of these good people around you, and your network gets larger and larger.

Having said that, there's always a slight tension. If you haven't got anything to show for the last year, people won't buy it. So there's a tension between having a shiny thing you can hold up — what's the thing you've now done? — versus the long term. You'll particularly find this with academic grant applications: if it's a two-year grant, at the end you have to have a thing you can hold up and say, "Here's the paper, here's what I wrote." But even then, you should be saying, "Okay, if I did this grant for two years, what will that do for me in five or ten years? How will I build on it?" — rather than just taking the short-term view. So, back to your piece of paper: you want a long-term plan. That's the most important thing, and all the shorter-term things need to lead up to it.

But don't take things too seriously or too personally. You will fail at lots of things. Some of the things you do won't work; you won't get that grant, that paper won't get accepted, you won't get the job you wanted. That's okay — it's the long-term thing that matters. There was a really good interview with Jason Kenny, the cyclist, at the end of the Olympics. He was very philosophical, and basically said, "Some days I'll turn up and I won't perform. Some days I'll turn up and perform really well, and someone else will perform better. But so long as, on average, I perform better than most other people most of the time, I'm going to win more than everyone else." I'm paraphrasing, but that's the concept. Some days you'll apply for a job and someone else is going to smash you, because they're better on the day. That's okay. The point is that you want to be gradually getting better all the time, working on that long game.

They're two slightly different questions. To answer the second one — not much at all, actually, over and above the things I've already talked about. Ultimately it's about productivity. And one of the easier things about clinical academia is that you do have metrics. You can argue about the metrics, but you have them — grant applications, publications, H-index, all that. And within reason, they can't really be argued with. If you publish a paper in the New England Journal of Medicine, you've done that. Other people can say, "I don't like it, I don't think it's a good paper," but who cares? You've done that thing, and you've got an objective measure.

So in some ways the academic side is easier. Which means that when you're going for jobs — particularly academic jobs — what matters much more is what you've done. What's on your piece of paper? What grants have you got, what papers have you written? That's what goes down there. And it's hardly related at all to whether you're the son of so-and-so, or Professor Lord so-and-so — that's not really how it works anymore. It might be different in other bits of medicine, but I certainly haven't come across it. So I think that's much less of an issue than people think.

On the general networking side: the network you build up over the long term is super important, because it gives you the opportunity to do all those things — to work with other people who want to do things with you, who'll come up with ideas and say, "Do you want to do this together?" That's really important. But I'm absolutely not a fan of forced networking. I've never found a single useful connection from any event I've been to. As you know, in the tech world there are all these awful networking events where people come and say, "Do you want to meet this person?" Nothing useful ever comes of it. I genuinely wouldn't bother. I've never come across anything useful from LinkedIn either, other than the odd friend saying, "I haven't seen you for a while." Personal networking, though, is super important. And my single tip for that is: if you can genuinely do something for someone, do it. That's how you make your network. Just saying, "Look, I was talking to someone the other day, you mentioned you're really interested in this, I thought you two might get on" — making an intro, with nothing in it for you other than genuinely making the connection. People remember that. Whereas if you go to some senior professor of renal medicine and say, "I'm a really good junior doctor, I'm so good at renal medicine, I can help you out" — that's not going to work.

I think you're right, but I'm just not sure. To some extent, the way we've been talking, it is a game — in that there's an outcome and there are rules, and you know the rules when you start. So part of it is: if you want to go down the academic route, don't go down it and then, 15 years later, complain, "It's not fair, I don't like these rules." You knew the rules when you started.

But I'd actually argue against the idea that there's a dichotomy here. I don't buy the position of people who go, "Oh, these are just academic metrics — what about real-world impact?" What I'd ask is: how are you going to measure that? What are the things that constitute your real-world impact? Most people can't give me an answer. Ideally, yes — real-world impact could be how many additional patients have got additional years of life because of the thing you invented. But how are you going to measure that? Usually you can't. You're going to have to use some sort of proxy. And the question then is: why is that proxy any better than the proxy of publications and citations? You'd have to show that it actually is better, and I'm not convinced that's been done for many of these things.

So there's an issue around how you measure impact in general — maybe we'll come on to that, it's quite interesting. But I wouldn't argue that these things are just "vanity metrics," as some people call them. I don't think that's true. There has to be some way of trying to objectively measure what you've done. If I've got, say, half a million pounds to give to someone from a funding body, and my choice is you or somebody else, how do I make that decision? Fifty years ago, I'd have rung up and said, "Is Musty a good chap?" — and clearly that wasn't a meritocratic way. So you need something objective. Now, you can always argue, "I don't like those metrics" — and the question then is: what metric would you like, and why is it better? Maybe in ten years someone will come up with a better one. But I'm not aware of one at the moment.

I'd say half and half. Realistically, if you're going to play a game, there's no point playing it and then not playing by the rules and then complaining that people say you're not playing by the rules. You chose to play. So there's unequivocally that part of academia around publications.

Having said that — if you forget things like predatory journals and the less favoured, less attractive routes people take, and you just look at the core journals — let's say the metric is a really simple thing: how many papers have you published over this time in these journals? Not the New England Journal, but a good, normal journal — the British Journal of whatever. It's all very well someone saying, "You're just trying to get publications," but for anyone who's tried it, it's not easy to get published in those. You have to do proper research. And therefore it is a way of assessing whether academic work is of an adequate standard. There are all the arguments — which I totally get — around peer review and whether it's valid, but no one's really come up with anything better at the moment.

That said, I've seen a massive change in the last 15 years in which journals people are published in, and the main reason is PubMed. You won't believe this, but when I was a medical student, if I wanted to look up references — I remember doing my BSc — I'd literally have to go to the library, to Index Medicus, which was these massive shelves and shelves of books, look up the author in the index, manually find the paper, then go to the shelf and read it. That's how you did a literature search, which meant the vast majority of doctors couldn't do it. So what they'd read was whatever journal the department got every month. If you were in obs and gynae, the department would get the British Journal of Obstetrics and Gynaecology, a couple of others, and you'd flick through the contents. That's how you kept up to date.

Nobody does that anymore — people just go to PubMed. So whether something is published in any particular journal is almost irrelevant now, because you can find it. The journal has become much less important — still important for certain funders, but overall less so. What's become much more important is whether people use the work: is it cited into guidelines, can you show clinical impact, are other people citing it and doing things with it? Those have become relatively much more important than the impact factor of the journal. Having said that, journals with massive impact factors are still prestigious, and always will be.

One of the defining ones for me was this. I originally trained as an obstetrician and fetal-medicine person, and wanted to do fetal medicine. I'd applied for — I can't remember exactly what it was now — a Wellcome or MRC intermediate fellowship, and was fairly sure I'd get it. I thought I had a good CV at that point. It was a big London hospital, not where I'm working now, but with all the right people, a nice project — everything about it made you think, "This is going to happen." Sometimes you're more confident than others. And I didn't get it. Because of the timing, I was thinking, "Oh my God, what am I going to do now?" and generally reconsidering things — whether I'd stay in fetal medicine or do pathology. Then, almost literally two or three weeks after I heard, there was a case I was involved with that got me interested in paediatric pathology. And a week or two after that, an opportunity came up for a post at Great Ormond Street, which I hadn't thought about before. And that's what I did, and where I've stayed ever since.

So at the time you think, "This is terrible, I didn't get this thing" — because it was your plan. But in reality, most of these things aren't that important in the grand scheme. You're not going to succeed at everything. You just need to keep perspective: sometimes you won't perform, sometimes other people perform better, sometimes it's bad luck. Don't cry about it — that's what happens. Be ready with the next thing. And it's back to the long game. It's not about what happens this year or next year. Particularly for someone in your situation, just starting: assuming you stay in medicine, which we hope you will, you're going to be doing this for 40, maybe 50 years at this rate with pensions. What you do for the next few years is, by and large, irrelevant in the grand scheme. It's all about positioning yourself so that, longer term, you're doing the things you want to do, with a bit more freedom. So don't get too — everything seems really important at the time, but most of the time it's not.

And on failure: if you're thinking about becoming a clinical academic, oh my God, you'd better get used to it. You will not get most of the grants you apply for. Most of the papers you write won't get accepted — or at least not accepted straight away. You'll get rejections. That's a massive part of it. I know loads of people who are Professor Lord So-and-so and still don't get the majority of their grant applications funded. That's the way it is. So if you're so sensitive that you don't like criticism and you don't like failure — clinical academia is not for you. It's a bit of a shock for people who haven't done much, particularly if they do a PhD early: they've spent two years on a thing, they write a paper, and it gets absolutely roasted by someone, and they take it really personally. You've got to get used to that, and go, "Okay — of this criticism, what's reasonable? What's fair?" And often you think, "Yeah, to be honest, that's a good point, we can address that." And some of it is bias, or whatever — but don't take it personally. That's a skill you've got to get used to.

To some extent it gets worse. If you imagine you've been in an area for three or four years — now imagine you've been in it for 25 years; your identity is even more wrapped up in it. So that doesn't get any easier. What does get easier is that you just get better at taking the rejections of grants and papers. And the other thing: when you're relatively junior, you assume that the senior people aren't getting rejected — that they're different. It's only when you see more senior people that you realise it happens all the way through. Even the most senior people in universities still don't get most of their grants accepted. Then it becomes much more normalised.

But there's always that slight thing. I'd be totally lying if I said that when I get a paper rejected, or get stupid reviewer comments, it doesn't slightly irk me and make me think, "What an idiot." But that's different from ruminating on it. I don't go to bed thinking, "Oh my God, why did that guy say that about my paper?" You just think, "Okay, he's doing his job, I'm doing mine, and that's the end of it." But you absolutely do have to get used to it.

I'll give you some perspective, but again — as an F1, take all of this with a pinch of salt, for all the reasons we said before. Whether it works for you or not, I don't know. But from all the people I've met who I'd consider the most successful clinical academics, the first thing is: you must become really good clinically in an area. Partly that's because you won't be able to be a good academic if you stop seeing patients — you won't understand what the issues are. And partly it's that you won't be respected, and you won't have colleagues who support you and respect what you're doing academically, if you're a terrible surgeon or you're not good at nephrology or whatever. So the first few years are about becoming really good clinically and becoming known.

Then you have to think: that's nice, but it's not enough. How do you add value? Early on, you can start getting involved in any kind of academic work you can, because you want to learn just by being around academics who are doing things. Don't stress too much about the exact topic. Get involved in some systematic reviews, some case reports — it doesn't matter what it is early on. Because if you go to an interview in three or four years' time — every single junior doctor applying for a fellowship or an ACL or similar will say, "I've always been interested in research." And my question is always, "What's your evidence for that? You don't look like you've been interested in research, because you haven't done any for four years. What is it you've been so passionate about that you couldn't be bothered to do anything for three or four years?" Whereas if someone says, "I've always been interested, but because I've been in this busy job, during that time I've done these five conference presentations, this case report, I got involved in this project with my consultant" — then you think, "Okay, I believe you."

And realistically, if you want to be a clinical academic, at some point you'll have to do a PhD or equivalent. The key is not to leave it too late. If you do ten years of clinical work and then your dedicated research time — you're not too late, I don't mean it that way, but the work you do in your research takes time. It's like compound interest: it takes time to accrue citations and for other people worldwide to know about it. So the earlier you can do it, the better for your career, because you've given it time to brew and establish a reputation in a particular area. So as soon as you more or less know what area you want to be in, earlier is better.

And when you're picking that PhD, don't worry too much about the exact topic — worry much more about who your supervisor is. Because what you really want from a PhD, if you've got a half-decent supervisor and a half-decent place, is — well, you'll get the PhD, that's fine, you'll get some papers. But what you really want is — this'll sound quite bad — what can you suck from that supervisor? That's the gold: what can I learn from this environment and these people that will make me better when I finish? So the key thing when you're picking your research is the person or people. You've got to have someone you look up to, whose company you enjoy, who you want to do work with, who you bounce off and get energy from. That's much more important than the specific project.

The more general thing I touched on earlier — that I wish I'd done earlier, and now do much more — is being explicit about how to measure or assess whatever it is you want to do. Let me give you something concrete. Say you said, "I'm not really interested in being an academic — I want to be the best surgeon in ENT." The question right at the beginning is: if I had a magic pill and gave it to you, and it made you the best surgeon in ENT, what would be different tomorrow? On a day-to-day basis, what would be the practical thing? Would you walk differently? Would you see more patients? Would the post-operative complication rate be lower? Would the patients be smiling more? What would actually be the specific difference?

For loads of things, when you think of it like that, you suddenly realise it's quite hard. And if you can't even define what being the best surgeon means for you personally — I don't mean league tables, though you might choose that, but for you personally — you'll never be happy. You'll never feel you've succeeded. So be really explicit about that. We've noticed this internally too, and it's been really useful. You always hear this stuff — and this is back to some of the work we're doing with tech — where there's talk about, "We really want amazing patient experience." But if I gave a pill and the experience was amazing, what would the patients do differently? Would they just be smiling a lot? What would the thing actually be?

That's a really useful lens for whatever you want to do. You want to be the best podcaster? I don't know what criteria you'd use. Maybe it's number of views, if that's what you choose. But if it's not — if you say, "It's whether people like my podcast" — well, how will you assess that? How will you know whether you're doing it well? Most people don't spend enough time just sitting on a Sunday, thinking, "What is this thing?" People say, "I'd really like to be happy," but that's just vagueness. What do you mean? If you were really happy compared to now, what would you do differently? Would you spend more time with your friends? Defining those things — whether at work, professionally, or for your own life — I've found really helpful. Because it also makes you realise that some of the things you're doing aren't actually consistent with what you're trying to do. You're doing them because other people said that's what you should be doing, or because that's what you ended up having to do.

I'd say yes, easily. The caveat is that very few people are going to say, "Oh no, it definitely wasn't worth it," because that would show a kind of sunk-cost fallacy — you think, "I've done all this stuff, surely it must be worth it." So the way I can best put it: if someone said, "Right, you can go back to being a medical student — would you do the same thing again? Would you be happy if the same thing happened again?" — the answer is yes. Although, actually, if I were a medical student now, I wouldn't do exactly the same thing, because I'd do everything around data and tech and digital — but that's a slightly different matter. I still get the same buzz today. If, after this podcast, I look at my emails and see that I've got a paper accepted, I get the same buzz I got as a first-year foundation doctor: "Yay!" That's still there. So for me, it's worth it.

Having said that, you do have to realise that you have to stop doing other things. Not in other parts of your life, necessarily — but, for example, I still really enjoy my clinical work, but now I only do it about 30% of the time. I wish I did more, but to do more I'd have to do less of something else. That's a tough thing you're always going to have to consider. This idea that you can have it all — see all these patients, do academia, do management — you can't. You're always going to have to decide what you're going to stop in order to do more of something else. And that's tough if you've got multiple things you like, because you think, "I want to do that, and that, and that," and you can't do them all, or not as much of them all as you'd like.

But I'd still strongly suggest — if someone in your position said, "Should I become a clinical academic?" — I'd definitely say yes, go for it. I think it's slightly different now from 20 or 30 years ago, but I don't think it's worse. It's still a really great career. And anecdotally, it gives you more options and more variety. The people who seem to struggle more, after doing something for 20-odd years, are the ones where it's the same every day. It becomes tough when you're just grinding through the same clinic doing the same thing. The advantage of clinical academia — or not necessarily clinical academia, but a job that involves your clinical work plus another thing, whether that's broadcasting or working with tech companies or whatever — is that it gives you that bit of variety, and it keeps things fresh. The people still bouncing around in their 50s and 60s are generally the ones doing more than one thing, because at least one of the bits is always still fun.

It changes a bit. There are certainly aspects that are easier — a lot of the machine-learning stuff we're doing now, I'm not running the algorithms myself, luckily someone else does that. But I still really like writing the papers and doing the dog work. Every single paper, I still like going through line by line, changing the graphs, doing all those things. That doesn't change massively. And there's something still grounding about doing the stuff yourself. Whatever happens, you should still do the same clinical work everyone else is doing, so you understand it, and you should still do the same grinding academic work everyone else does — you just may not do as much of it.

The thing that does change is that you get more opportunities, because people come to you and say, "We want to do this," and you get brought into something, as opposed to always having to find a way to drive it yourself. When you're more junior, you have to push much more; later on you have a bit more flexibility. But it's still fun.

No, I think I've rambled on and talked a bit too much already. But all this kind of stuff — how to plan what you're doing in medicine, how to think about your career, how you're going to work — this stuff is, I'm fairly sure, still not taught in medical schools. There's more and more now about how to learn — a massive selection of podcasts on that — but there isn't much on how you do things once you've qualified. It's not about exams anymore; it's about how you're going to do all of these things. And there are lots of tips where you think, "God, if I'd known this 20 years ago, it would have made things easier." It wouldn't necessarily have changed your life, but it would have made everything a bit easier.

So I get slightly frustrated that there's a lot of this out there, but it's quite hard to find and it's not focused. I think one of the core things, when you're having your induction — instead of lifting and handling and how to sit on a chair — it would be much more useful to have sessions on how to be a doctor: how to plan your day, how to work through all the tasks you need to do. Rather than much of the mandatory training, which tends not to be that useful.