Creating Supportive Teams: Imposter Syndrome and Psychological Safety in Theatre

This episode features a thoughtful conversation with Professor Sadie Khwaja, a consultant ENT surgeon in Manchester, exploring imposter syndrome, confidence, and psychological safety in surgical careers. Sadie shares her personal experiences and research, highlighting that imposter syndrome is extremely common, even among accomplished surgeons and discusses how persistent self-doubt can impact mental health, performance, and career progression. She emphasises the need for a supportive environment, mentorship, and open discussion about vulnerability, especially for women and minority groups in surgery.

The discussion moves to strategies for building confidence and resilience, including the importance of a growth mindset, feedback, and tailored mentorship at every career stage. Sadie also highlights the importance of psychological safety in the operating theatre, emphasising the need for clear communication, pre-operative team planning, and leadership that fosters participation from all staff. She offers practical advice for creating inclusive, supportive work environments and stresses the ongoing responsibility of trainers and leaders to invest time in nurturing the next generation of surgeons.

WENTS & Friends is the official podcast for Women in ENT Surgery UK.
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Thank you to all of our guests for this season and to Karl Storz UK and the ENT UK Foundation for sponsoring season two of Went and Friends, the podcast of Women in ENT Surgery.

This season’s episodes are hosted by Alex Ashman. Produced and directed by Heather Pownall @heathershub of Heather's Media Hub Ltd. The podcast was created by Ekpemi Irune. The rest of the team includes Anna Slovick, Katherine Conroy, Marie Lyons, Tanya Ta, and Alex Ashman. 

Transcript

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Alex Ashman 

This is WENTS and Friends, the podcast of Women in ENT Surgery UK. I'm your host, Alex Ashman. This season, we'll be looking at key career advice on returning to training, working less than full time, and applying for fellowships. And we'll be looking at factors that can make the working lives of women and minority individuals more challenging and what we can do about them. 

Today, we'll be talking to Ms. Sadie Khwaja consultant ENT surgeon in Manchester, about the subject of imposter syndrome, confidence, and psychological safety. But first, a brief word about our sponsors

The WENTS and Friends podcast is sponsored by Karl Storz UK who have kindly supported the podcast from the beginning and continue to do so for a second season. The podcast is also sponsored by the ENT UK Foundation who have supported this season with an educational grant. Thank you to Karl Storz UK and ENT UK Foundation for their support. 

Professor Sadie Khwaja is a consultant laryngologist and rhinologist with interest in facial plastics in Manchester, with interests in medical education, NIH research and leadership. She is SAC LM for ENT and curriculum lead.

She co-led MAC mentorship and coaching hub for Health Education England Northwest from 2019 to 2024. She's a committee member for the British Society of Facial Plastic Surgeons and British Laryngology Association. She's also a founding member of the ENT UK Foundation. So Sadie, thank you so much for joining us.

Sadie Khwaja

Thank you, a pleasure to join you and talk about this subject matter.

Alex Ashman 

So first of all, we were going to talk about imposter syndrome, what it means for surgeons and what it really is, whether it's a personal thing or not.

Sadie Khwaja

So thank you. Thank you for the invite and appreciate it. It's challenging conversation, actually, imposter syndrome I think it's commoner than we think. And I did have a little bit of research just in preparation for today. And it's 98%. So it suggests that we all have had experience of it. It's how we experience it. And I did have a look at the definition, what is imposter syndrome? So in definitional and it's persistent self doubt, inadequate or feeling inadequate or fear exposure as fraud, despite having clear evidence of competency and success. I think what as a surgeon, we are perfectionists and that doubt is part of who we are because that makes us good surgeons.

But when that creeps into kind of over-doubt or feeling inadequate, then it brings in another level of inadequacy that challenges us. And I think that's where we have to have that balance. Because that one side is that it can lead to anxiety, depression, and actually feeling burnt out, you lose your confidence. The other side of it, and I've seen both sides, I think, the other side of it is when you see the over-confident surgeon the kind of fields that can do everything. And you feel a little bit insecure about that as well. So it's a very much a balance that we have to find in ourselves, but also to achieve that, because we're all learners, is how to have that in a very supportive environment. And I think there's our challenge. So, you know, in a very busy world, you're a trainee, you're trying to get up the ladder and get that level of experience and you're doubting yourself in that journey and you need that support because somebody, it's that kind of two elements to it. It's that reflection, personal reflection on where you feel you are at. And then there is actually a critical friend who can support you. That's a mentor. Now, the framework that we have at the moment is your educational supervisor should hopefully be that critical friend and be able to support you.

We all know that's very variable, depending where you are, who you are, on getting that. So it's going back into surgery is a specialty that is a perfectionist kind of culture that we have requires evaluation and being critical about surgeries. And it's finding that balance of doing that in a supportive environment. And the challenge we have is how supportive is the environment in the world that we live in where it's fast-paced, decision-making and challenging. And I think really the kind of question I would say is how do we create that culture? And I think the first thing to say is recognise the prevalence of imposter syndrome. It's common. Let's just put it out there. It has a slightly, it is more common slightly in the females and those in the early journeys of their careers. And I think we need to look out for those trainees and support them. And it's an open discussion. It's really let's put it on the table. Let's see what those challenges are. And then having that right person to be listened to, having that access to support, really. So if you're, you know, education supervisor isn't appropriate.

Is there another wider network? Is there a mentor who is female who might be more supportive, understand what the journey you're going through and how can you access that? So I think that bigger, wider environment outside of the framework of the training is really helpful. And recognising, you know, it's a vulnerable period, isn't it? When you're being challenged or you feel insecure about your kind of skill set or your kind of this kind of what you're producing. And I think that that vulnerability needs to be recognized as well. So I think those are the things I think about when somebody asks me about imposter syndrome.

Alex Ashman 

Yeah, I guess the other thing I think you're possibly leading into there then is whether someone personally has a sort of a growth mindset and they say to themselves, well, I can't do everything yet, but maybe I'm going to learn how to do things. I'm not going to compare myself to people I view as being perfect or very advanced, but instead I'm going to learn from how they've got there and, you know, take on those people as mentors, you know, work on myself, but know that actually I'm not the finished product necessarily and learning is lifelong. So I mean, 

is there such a thing as the finished product really? We're all on this journey together. And I guess also, as you say, recognizing that everybody has these doubts. They don't necessarily share them, but everyone has their own problems, their own struggles. And recognizing that you're not the only one in that situation, I think it's probably very empowering, isn't it?

Sadie Khwaja

It is and I think for my own personal journey, think, you know, when do you reach the point where you put your hands up and say, you know, I made a mistake and I want to share with you that challenge so that you don't make the same one and so forth. I think comes with confidence and comes with experience, comes with sharing. And we all kind of happily and I've been there sitting in the kind of surgeon's room talking about I did that case last week. was really difficult. I do know having that ability to do that comes with a little bit of experience and confidence. And I think comes with that safe environment again. Obviously, for us as consultants, are in that environment because our timetables are fixed and it's you know, I've been there for 10 years rather than somebody who's a trainee comes into a new environment every six. I find it very challenging and I feel very challenged for trainees to be rotated so fast. I just don't get four month rotations. Six months maybe gives you time to embed into that place, get to feel, be able to open up a bit to have a conversation. Because we're all different characters. And I think those of us who are very communicative and able to explore and share, yes, that journey of moving around is doable, shall I say rather than for those who have a quieter characteristics and personality. It's a nightmare, think, actually. I mean, it sounds a bit harsh, but you know, I mean, it's, you know, it's a challenge. And I think for those people, having a framework slightly sitting outside, somebody who can go to regularly really, really helps. Because as you're rightly saying, it's that reframing is what we're looking at. None of us are perfect.  None of us get it right 100%. I think it's just being able to know that, I think, that insight, isn't it, into that.

Alex Ashman 

Yeah, absolutely. I've noticed when mentoring programs try to cover everyone or try to reach quite broadly, it can be quite difficult to pair people up. you think trainees and course, consultant surgeons as well and SAS doctors should proactively themselves look for mentors and try and find people that they can have a chat with, who they click with or who they feel can give them those insights locally or regionally.

Sadie Khwaja

Yeah, it's a good question. And I think part of our mentorship and coaching hub was one of those challenges we really struggled with in trying to get that right environment. And I think when we sat down to think about it, we kind of created, and it'll be on the website somewhere, at least about 10, 12 kind of subject matters. So there's a whole broad level of conversation that is relevant, first of all. Secondly, finding the right mentor. And I would say you need a mentor for different periods of your life for different things. So, you know, if it's a training issue, but it's not within the, you don't want it in within, it depends what you want really. If it's not somebody within that hospital, then you need to be looking within that deanery area. So somebody you're close by, but not too close.

So, because some of the conversations very private and you want to have it in a safe space. So I think it's horses for courses. So it depends what you're looking for and who is the right person. So I would say the basics of what we were teaching or training in the MAC kind of program. And I still do to this day is run a mentorship workshop. And that is to get everybody’s skill set up to the to what I feel you feel that you can call yourself a mentor. Because I think we're all technically, we can all give advice. Somebody comes along on the corridor and they want some quick advice. But that's who we are as surgeons. That's what we do day in, day out. To be giving mentorship, I think, is a slightly different thing. It's investing in a person, sharing with time, because you need the time to allow that person to open up, to able to share with you the challenge that they're having. And then the experience being the person you've got the experience to provide that for them. Now you may not always have the answer to everything, but you may know the person who they can go to. So it's that kind of finding the right conversation to have and then the kind of the right advice to give, or communication or coaching as well. So it may not always be advice that they need. It needed to be a supportive coaching environment. If we go back to the imposter syndrome, the ability to reframe and kind of think, actually, you know what, even though I saw all the negatives, but there was a lot of positives in what I did. Yeah. And then work on the positives and say, actually, you know what, I did that really well. And, you know, if I do that a little bit more confidently and say next time, you know, surgeon X, I can do this bit really well. Can you let me do the X, Y? So it's that reframing of a conversation and supporting somebody through that journey.

Alex Ashman

Yeah, absolutely. A sort of similar topic. I also wanted to ask, what do you think makes surgeons underconfident and how can we address this particularly for women and minority surgeons and trainees?

Sadie Khwaja

Yeah, and I think that's a really good question because I think, and I always used to think about this, is, you know, we're surgeons in a theatre and we're doing a performance. And in doing that, we are actors and we're all different types of actors, aren't we? Some of us are, have that kind of bravado and that kind of kind of outward expression. Well, so otherwise, does it mean that's right? I'm not here to say that's what we should be. I'm just saying there's a whole range of what we class as a surgeon and the characteristics of them. But I think from a confidence element of it, there is definite themes that we need to kind of recognise in ourselves. So straightforward ones is the skills and knowledge and experience. You need that foundation. You need to be able to have the skills and the knowledge on the case that you're going to do and have seen it before and be able to be confident in order to do the technical skills required. So that's your kind of say foundation. 

Then the next step is actually a self-reflection and it's going back to what you were saying about your growth mindset. So be able to say, okay, I know how to do this, but maybe I should have done it slightly different or I need to pick up from my trainer. He did it slightly different to me and that was what made the difference. So that kind of self-reflection post procedure allowing you to kind of say, how can you know, there's more than one way of doing something what suits my hands. It may not be what the trainer said, but you know, if I try it this way, it may work better. So that kind of constant reflection gives you the confidence to kind of try things. And I think that's key for building your confidence. And then listen, who hasn't been put down? mean, resilience without it, you know, it's a challenge in every walk of life and whatever we do.

So having that resilience is really key. I'm not sure whether you can answer this one, whether we all have resilience to a certain extent. It's just bearable. I don't know.

Alex Ashman 

Yeah, well, I was going to say, I was going to say, honestly, I think some people they've used up all their resilience. don't know, getting the kids to nursery, getting to work, driving an hour, getting in the building, you know, walking past people who've been working there for years when they're a new trainee who's only been working there a few weeks and you're thinking, God, I don't belong here. And then just to get in the front door and get into theatre and the only see the patients then, you know, by the time you handed the knife, maybe you've used up your allotted amount of resilience, even if you have, you know, more resilience than the average person, you might have, you might be using all that up just to get to the starting line. So I don’t know, I do wonder if there are ways that, you know, trainers can recognise those under confidence slash, you know, sort of, uh, resilience, exhausted trainees who need a bit more support or a bit more coaxing to get the most out of them.

Sadie Khwaja

It is, and it's really good question, a good point actually, because I always find definitely, I mean, I've got the one son, but it was the vision I always had it of juggling and of plates in the air constantly and, and trying to kind of, you know, trying to focus down to one, anyone type and making sure all the other ones were in the spin. And it's hard work. And I think if nobody recognises that, that's a shame because actually it is, do know what it makes you? It makes you multifaceted, makes you actually much more rounded and you're a much better communicator with your patients and with the kind of the environment of theatre because you know, know, what is it? 70 % of it would be female because you know, most is scrub staff quite lot of anaesthetics are female. So, you know, there is that kind of commonality there that, you know, that you can share with. But as you're rightly saying, even just to get into the front door is a challenge. And it's finding those small wins in that, you know, if it's a bad day, you know, the nursery didn't open in time, you've got to theatre late, and now you're doing catch up after catch up. It's recognising that's the situation.

You can't reverse it, that's what it is. But saying, know, apologies, I've got here late. Let's see what we can do to kind of make the situation work. And I think what happens is that we all think in a very singularity way, as in, if I don't do that, that's going to happen. But you know and I know, theatre runs, ideally theatre runs on time, but majority of time, there's 101 reasons it doesn't.

And, you know, there's always a bit of flexibility that you just need to kind of work with. But again, go back to same thing, isn't it? You need a supporting environment who appreciate that these are the challenges of the world we live in. We live in a really busy world and we need to recognise that, I think. But supportive environment is really the best way of keeping your resilience up.

Alex Ashman 

Yeah. I mean, I wonder is the, do, do trainees need to proactively get their trainers to be supportive or, should trainers generally sort of, you know, try and be proactive in supporting the trainees or is it kind of a 50 50, you know, sort of, I don’t know, team teamwork to make sure that happens.

Sadie Khwaja

You definitely need a supportive trainer because nothing is gained by the conversation that you have when they say, I'll just take over now because we're running late. And that really is when you feel you're your stomach, don't you? Because you're like, but this is my opportunity to do this case. And you're like, gosh, you know, and when will I do the next one? now I'm going, you know, it just sets up a whole chain reaction. But I think that's conversation is communication. think this is really what we're talking about. There's an element of communication and leadership here, which is about, you know, owning the situation, sharing it, saying, you know, yes, we're running late, but the element that I really need to get my hands on is that bit of the operation. If you can let me do that bit, then obviously let you do the rest.

It's not easy to do in a kind of busy kind of everybody's looking at you and the anaesthetist is looking at the watch and everything else so it's a hard conversation to have so it's best done outside of the theatre environment and prior to going in and saying you know it's we're running a bit late but I need to do this bit if we start or it's a negotiation isn't it ⁓ let me get the patient on table I’ll start and then you come in. That kind of conversation needs to be heard.

Alex Ashman 

Yeah, I think that's very sensible because having that conversation one-to-one with the boss in the coffee room beforehand is a lot easier, I think, for some trainees than, you know, saying, right as the case is beginning, right, can I do this bit? You know, and also I think probably the trainer wants a bit of time to maybe quiz the trainee, you know, okay, what's your experience if they haven't worked together much? So, yeah, that's a very good point. You want to have that conversation ahead of time and then being given that period of time in theatre to do for, you know, for training, probably will give those underconfident trainees a bit more, I don't know, bit more confidence to get on and not worry so much.

Sadie Khwaja

It is. And you know, the other thing I would always say is actually ask for feedback. I think we're very poor at giving it. Definitely as trainers. It's not hard to do. I just feel it's just, again, it's that communicative kind of element. So in that conversation before you go to theatre, I'm going to do this element of it. I'd love your feedback to say, would you do it differently? Would you kind of, is my technique needs to be improved or do something else on it? I think having that, you set the scene, then you're just playing, you're the actor in it. If you come in as in the kind of standing or come in at the last minute, it just sets everything off in the wrong direction, doesn't it, I think.

Alex Ashman 

Yeah, yeah. Yeah, absolutely. No, and I agree, particularly from the medical education point of view, you really have to have a little sort of quick structured feedback immediately afterwards, like a sort of hot debrief, like what went well, what could be improved, how are we going to change things going forwards? And then maybe what are we going to do to support that in the next few lists or I don't know.

Sadie Khwaja

I mean, I'll give you an interesting, I was only yesterday actually, we were in theatre and I have a fellow and so it was a difficult case. It was basically a micro laryngoscopy taking a cyst off the vocal cords, but it's a very fragile cyst and it burst and I saw her face and I recognised instantly she was kind of, you know, self flagellating as you do at the moment. I said, you know, we talked it through. We talked it through on the table. OK, what are we going to do? How are we going to manage this? What's the challenge? And you really need a good trainer to let them work it out on the table rather than do that instant thing. Right, well, I need to pick this up now and sort this out kind of thing. And you're like, is that really going to help her in the long run?

That kind of emotional intelligence you need to be able to recognise that kind of very stressful moment for her. And so I think there's a lot to take out when we go to theatre and really, as I said, setting the scene and then picking up the cues, picking up the kind of, know, stresses that are occurring on table is really important as well.

Alex Ashman 

Yeah. And that kind of then leads me to ask about the more broader question of, you know, creating an environment where there's psychological safety, you know, for surgeons, trainees, the wider, you know, staff, but in particular, I want to talk about how, you know, psychological safety affects surgical practice and, know, what happens obviously when it's not there.

Sadie Khwaja

I think that comes with being able to feel comfortable to speak up is really the summary of that. And I would say if I had to summarise this topic, I would really recommend everybody. I think it's not compulsory yet, but I suspect it will be. It's doing a Knott's course. Because the Knott's course really looks at those elements of it, feeling of it, taking out the hierarchy, really saying we're all invested in this patient on the table. We all contribute to getting that safely onboarding done and taking the patient off the table. Because at the end of the day, this is all about a safe environment for the patient. And how do you create that? And that comes with listening to everybody who's contributing.

We work in an environment where there's a constant drive of how efficient can we be in theatre? What's the safe staffing numbers and things like that? And we just sometimes forget the element of kind of the quality of who we are and how we make that environment safe. even the scrub runner that was supporting the scrub nurse has an essential part to play, you know, getting the right equipment on the table that you need at that moment in time that you need it, which wasn't considered at the beginning of the surgery because hey, you can't remember 101 things at the same time, you know. So I think those kind of elements, but it comes with kind of behaviours and having that leadership behaviour.

Alex Ashman 

Yeah absolutely

Sadie Khwaja

Now, the way we work theatre is very much there is an element of hierarchy. There's one person, the surgeon, responsible for all of that kind of interaction going on. So how that person leads and their behaviour to open, have an open conversation, to invite everybody to speak is really important.

I think it's always good to have a look at where on your journey as a trainee, as you go around, where you've seen that work really well and really try and see if you can copy that kind of environment.

Alex Ashman 

Yeah, absolutely. I think that makes me think of the sort of whole civility saves lives and avoiding rudeness because obviously you don't want to cognitively impair your scrub staff by being rude to them, then ask for the very specific, I don't know, what's it from the cupboard at the back. When they're sort of, you know, they've got a pulse rate of 100 and dripping with sweat from being yelled at the rest of the day, they're not going to find the thing you want.

It also makes me think of, in terms of including women and minority staff and surgeons in particular, it does make me think we've got to be mindful not to do things that will be microaggressions or micro rudeness’s that we're not aware of, but which are going to impair them cognitively because they're busy thinking, my God, that surgeon said that thing that was really inappropriate. And now I have to concentrate on trying to get them to let me train and maybe, you if you go around being rude in front of your scrub staff, they might not be so inclined to speak up when you start taking out the wrong tonsil, the wrong hemi thyroid or something like that as well. So I guess it really, it comes back to the surgeon in the end. If the surgeon makes the environment hostile or, you know, not sort of comfortable for the team, then ultimately the team are not going to be able to support the surgeon as much. So I guess it's in everyone's interest.

Sadie Khwaja

Yes it is and if we just take a step and think about why is that and I think that lots of change has happened. We have that who element of our kind of theatre list starting. Where is that and I think the culture has changed. think definitely when it came in everybody thought why do we need to do this? You know this is just simply a checklist check, check, check. We're all done. But you know if you again if you see it where it works really well.

I'll give you an example. Like yesterday, my day starts with actually two things. The day has to have these two elements, otherwise I can't function. One is obviously see the pre-op patients, make sure you welcome them and they understand what they're doing and the whole contact procedure. I love to see a face. I love to see my face. I cannot operate as somebody I've never met. I can't operate on somebody I don't have had a journey with. So that's the beginning gives me the confidence to start the day. And then the second thing is the one-to-one conversation I have with the scrub sister. I go out and find her, even if she's running around, and I go, right, you've seen the list, let's walk through the kit you're going to take out. And you need to invest as a surgeon, as a lead, in understanding what is on a tray, what instrument it is, if it's not there, what your plan B is and possibly even Plan C. Once I have Plan A, B and C in place and I've seen my patients, I feel confident I'm ready for the day. And that allows me then the time to have the conversation with the rest of scrubs team to have how are you guys, how's the day, what you've been up to and set the scene, talk to the anaesthetists. That then gives me time. And then as we're operating,

And I have to go to Plan B. It's not even a question. Plan B was already in Plan B, ready off the shelf on the side, not chasing down a corridor into a... I mean, have... This whole planning has been over years. I'm not saying, you know, I came to this straight away. This is with those conversations where I've asked for something and it's in the corridor or the back cupboard. And I had to reflect after reflect to see why was I in that situation? How is it that I was going to change this?

And it was for me to change because I'm the leader and I have to make that change. It's not anybody else's job, really. So, yeah, that's years of experience and reflection and that kind of environment setting and culture that I really love to kind of create. And then, you know, that's happened really well because the end of day of the debrief is not often, but it's very rare. There's an instrument missing or something. That's the end of the debrief rather than, you know, there was any issues with communication.

Alex Ashman 

Yeah. Um, I guess the other thing I'd ask if you're, if you're not in that situation, say, I'm going to be really mean and ask a harder question here in terms of, say you're in an ad hoc team, you know, a team that's been flung together at the last moment. Um, and you don't have that opportunity, you know, to sort of build the cohesion over time and also, you know, sort of ahead of time. Um, is there anything else you would do to try and make sure that, you know, everybody speaks up? Everyone's included, you know, if you're working with people you haven't necessarily worked with before and you're kind of thrust together in that moment.

Sadie Khwaja

Yeah, you need to invest. You're going to invest some time to set that environment. So I would still do what I've just done, what I've just described. Yeah, but you need to invest a little bit more in saying hello. And there's nothing that beats a smile. It's free. And it actually allows you to open a door and communicate. And it allows you to actually say, actually tell me what your experience is. Have you seen me operate? Have you seen me? Have we done this case together before? Or have you seen this operation? And if you do it in a very much supportive way of doing that, which is let me learn about what your experience is and actually, you know, say that, OK, you haven't seen it. So let me guide you through how I do it. So this is what I like when I do this operation. And what we can do with is.

And I have been there with this as well, where, you know, basically, years and years ago, it's like a tonsillectomy. Now, tonsillectomy in my head is ding, ding, ding, ding, five steps, you're done. But to get that efficiency in that procedure, I need the set instruments given to me into my hands when I'm doing it. And so I had that conversation with the scrub nurse and I said and she said, yeah, Miss X does it this way, Mr. da da da, does it like that. I said, that's great. So you know what it's like, what the steps are. But do know how I do it? And she said, no, I haven't scrubbed with you before. I said, great. OK. And we set the table, her scrub table out the way I wanted to have the instruments handed to me. And basically, we went, I said, step one, two. So she learned how I wanted to do it. So it's an education for her. She learns some of that is instrument learning, some of that is procedure learning and so forth. She's not confident that she can do that procedure because we've just walked through it. And so in that way, we're both and I don't feel the stress because I've just shown her how I want it done, you know, and it's communicating again. We walk it through. So I think coming back to the point of, know, it's environment that you're not comfortable with, you're not being in that theatre. You need to invest the time have the communication early, not on table, not when you're in there. And I think that preventative element to definitely how I work is really keeps me my sanity, my kind of level of kind of stress as low as I can keep it. And I think that's the thing, it's something I love to kind of culture in all of our trainees. That's the kind of the message I try and get through as part of a surgeon training aspect is obviously this technical skills, but it's the non-technical as well that are really important for your well-being and your stress levels and your safety for your patients, that kind of thing. But I was going to say, because I've kind of focused slightly on myself, just about, you know, you talked about, you talked about females and stuff. I think the principle is still the same. It wouldn't change anything I've said. I think the nuances are just going to be communication slightly. If your first language isn't English, it's the challenge of how you communicate. And the answer really is. And I think it's a precious speech. I think I've seen it so many times. If you speak a second language, what happens? You speed up. And the answer is slow down and just say things confidently slower and you get the clarity.

And then the other person isn't second guessing what you're saying or mishearing what you're saying. And I think that then gives you that confidence on the communication and builds your confidence going forward. And I think as we've talked about females, I think there's more of that imposter syndrome and tackling that elements of it from that side.

Alex Ashman 

Hmm. Let me ask you then, say you've got someone who's starting as a new consultant and, you know, maybe a trust or, you know, a unit where they weren't a trainee, so they don't really know everyone. So they're going to go in with, you know, maybe low level of confidence, maybe feeling a bit of imposter syndrome still despite having CCD, et cetera, because I'm sure, you know, everybody has these feelings when they're somewhere new. How do you sort of maybe not pull yourself up by the bootstraps. So how do you sort of get into that situation where you're not feeling underconfident or struggling in that new environment?

Sadie Khwaja

Mm-hmm. Yeah, it's an interesting question because, yeah, it's most of us when we come to finding a job, we usually have a kind of a six year interview, don't we? So very much it's a kind of very much and I call it a marriage in a sense, because you need to fit into the environment or the place you. So when you go for a job, you would have thought this is a place I want to work. So that kind of conversation on your side as a trainee. And then equally on the other side, they have to see you fit into that the rest of the group. And there's a forward and back element of does that marriage actually work? ⁓ That sometimes it's a testing period that first and it's definitely the first couple of years, you're finding your feet, they're testing you out. And you know, is it going to work? So it's really stressful, I think. And therefore you need your framework to support you through that and what does that look like? That requires you and I definitely had it so it actually happened to me. I took a post-op in a hospital I've never worked in. It was doing the stuff, was rhinology, facial plastic, so I was happy in the technical side of things because you know that's what I trained for six years but I had not known, I didn't, I hadn't met or knew the other consultant group basically.

But what happened for me, don't know, whether you call it luck or whether it was designed, the senior consultant took me under her wings and basically pretty much became my mentor for the first couple of years. And what she did was, the thing that I think always stresses new consultants is the environment, getting used to it, but also the on-call for the first time and being on call and a case that you may,

You would have seen it as a trainee, but you're now at the end point where your decision is the final decision and knowing is that the right decision. You always need a telephone call to somebody who's had more experience to you because first of all, I don't know the lay of the land. So more than once I'd ring her up. She's not on call, but I'd ring her up and say, look, I've seen this case. This is what I want to do. And she would say, no, actually, you need to transfer that one out or you need to do something different.

And I think that's really absolutely essential because where does the challenge comes or the stress comes is whenever there's a transition point. So whenever you transit from a foundation to a core or core to senior or senior to consultant, that's where your stress has come. And that's where your mentorship or your support network needs to be put in. And that allows you to then take those confident steps knowing that there's somebody there in the background to support you through it.

Alex Ashman 

No thanks, those are very good points. Thanks so much for talking to us today. Is there anything else you wanted to cover before we finish?

Sadie Khwaja

Mmm. No, I think we've raced through a lot there. I suppose the message is, as I said probably a few times, it's really it's a really important thing. It's common. Imposter syndrome is common. I think we just need to recognise that it is needs a lot of light on it in order for us to land it safely for everybody. So I think there is a lot of learning still from my side of the kind of side of the point, shall I say, from trainers and people in medical leadership in creating those opportunities and frameworks or educating trainers. So, you know, it's for us to train the trainers to allow them to have the ability to support the trainees.

So there's always work on that. So there is education days and so forth. But I think hopefully trainers can see that, you know, there are solutions out there. We just need to invest in them. And most of the investment is time. That's the challenge. Most of the time.

Alex Ashman 

Yeah. Absolutely, Thank you so much. Thank you so much for talking to us, Professor Khwaja mean, congratulations on being a professor now as well.

Sadie Khwaja

Brilliant. Thank you. Yes, I'm getting used to it

Alex Ashman 

Thank you for joining us for another episode of WENTS and Friends, the podcast of

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WENTS and Friends is produced and directed by Heather Pownall of Heather’s Media Hub. The podcast was created by Ekpemi Iruni. The rest of the team includes Anna Slovick, Katherine Conroy, Marie Lyons, Tanya Ta and me, Alex Ashman.

Next week we'll be discussing fellowships and alternatives. Until then, take care and thanks for listening.