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SEASON 1 EPISODE 3, DR. JEAN-YVES KANYAMIBWA AND BENJAMIN LEPKE

Benjamin Lepke 00:00

Hello, everyone, and welcome to episode three of our 1 in Focus series which aims to have a conversation with our working doctors, who we've got good strong relationships with, or our internal staff to get an understanding of what it is, what they do, where they've come from, and what they've been through to get to where they are. So, this week's episodes, I'll be talking to a very good friend of mine, Dr. Jean-Yves Kanyamibwa, who is currently residing in the Sunshine Coast and hailing from Rwanda and in the UK and over here. We're going to have a conversation with him about his pathway to where he is now and what now sits ahead of him. So welcome. We'll call you Yanni.

Dr. Yanni 00:54

Yeah. Thanks, Ben. Thank you very much. I'm honoured.

Benjamin Lepke 00:59

Jean-Yves Kanyamibwa known as Yanni.

Dr. Yanni 01:00

I'm honoured to join you on this podcast. I really appreciate everything you've done for me. When you asked me if I'd be happy to do such a thing, I was very happy to help. You've been very key in my path to where I am here in Australia. So, it's a small price. It's a small token, not even a price. This is a token of my appreciation.

Benjamin Lepke 01:22

Thank you. Well, good place to start, so why don't you tell us more about yourself, Yanni. Where do you come from? What brought you to Australia?

Dr. Yanni 01:32

I was born in the south of France in a town called Montpellier, with my brother who was born a couple of years later, Jean-Hubert moved to Rwanda. In Rwanda there was a war there that happened, so we were refugees for a little while in the Central African Republic, and then flew to Cameroon, then to France, where we settled for a year, then a year and a half in Montpellier again. I did a bit more of my primary school education there, then moved to the UK to Cambridge, hence the British accent from about the age of eight, where I did most of my schooling there. I went to University at St. George's Medical School in London tooting then graduated in 2011. I did my F1 and F2 years, which first was the second year PGY1 and PGY2 in Cambridge and in Kingsland so East Anglian deanery, where I was from. I then moved over to Australia in 2013 in Newcastle, that's how I got here.

Benjamin Lepke 02:38

Very good. Where you taught in French when you were a kid?

Dr. Yanni 02:41

Yeah, I basically spoke just French until I was eight, and then, learned English when I moved to Cambridge.

Benjamin Lepke 02:49

How was that transition to the UK? Do you remember?

Dr. Yanni 02:52

Yeah, it was a culture shock, and it was interesting, you know, like, it's all just the food it was hectic, custards.

Benjamin Lepke 03:01

Like going from snails to custards.

Dr. Yanni 03:05

Going from frogs and snails and like, croissants to sponges, well what the hell's going on there?

Benjamin Lepke 03:14

The joys of British cuisine. Well, so you did that in the UK. Got to F1 and 2, what then? What made you make the decision to move to Australia?

Dr. Yanni 03:26

Yeah, I guess there are definitely push and pull factors. You know, for me growing up in the South of France a little bit and in Africa, the weather is one thing, but the NHS and its dysfunction. I remember when I actually left and had an exit interview with my urology consultant. I remember Mr. Mahesh Kumar, said to me, “Yanni if I were you, I'd go to Australia and not even think about coming back for the next five years’ and that was 10 years ago. So, it was just a sense of adventure, a bit of wanderlust, and just a sense that UK was probably heading for some trouble. It did materialise, Brexit and the rest of it, COVID so yeah, I wasn't really sure whether I wanted to do emergency initially. In the UK, I was more into anaesthetics, maybe paediatrics, anaesthetics, and then I kind of fell into ED well. I fell into ED and then I realised that it's actually a different specialty really. It is practiced differently in Australia and it's more interesting here. Well, I always explain it as if you think of the critical care specialties of ED, anaesthetics, and intensive care - this is just a big generalisation to explain it. If you create a Venn diagram of all those three specialties and think about all those key jobs and procedures within a hospital. In the UK, key critical care skills and procedures that one will be expected to do. In the UK, I found that the anaesthetist had a great proportion of those skill sets in the hospital. So they ran the MET calls, and the retrieval services have a lot more anaesthetists. I found that you're more likely to see intensivists in the UK than you are here, and the intensivists or the anaesthetists, that train and ICU in or vice versa, then you are here. Then your ED and emergency A&E in the UK, it's sort of left to wither on the vine a little bit and you're much more of the term, it's used a lot, as a triage monkey. The KPIs are more draconian, and you're expected to see someone turn them around and sort of kick them off to a specialty social assessment unit or to a medical assessment, within an hour, hour or two. But you're not really seeing people, you're not really using your skills as much. When I came to Australia, I'm intubating, more, doing more procedures, you're spending more time. I just found that the training was more extensive and the clinical acumen, I guess, was more robust. That was my opinion, and that attracted me, and I was oh okay, this is potentially quite interesting.

Benjamin Lepke 04:28

That might be the transition of why you initially wanted to do anaesthesia in the UK, and now moving into ED.

Dr. Yanni 06:08

Yeah, and I still maintain that if I was in the UK, I would have probably done anaesthetics.

Benjamin Lepke

Yeah, why do you think there’s that difference?

Dr. Yanni

Wow, that’s an expansive question, actually one of my last job interviews, actually for the Alfred, they threw that in the interview, they said, "So what is the difference between Australia and England?" I was just like, wow, are you really going to ask me that question? Why? I'll try to answer that question succinctly. I think it is multifactorial, you got to understand it from a kind of socio-economic perspective, sort of outside of the hospital, there are lots of forces. So, the UK has almost 70 million people and older healthcare infrastructure, my impression is that there is less money in the system anyway, and there's way more pressures. So at the point of service, at the point of patient contact, there's so much more pressure in the system to see any sort of unit of patients as quickly as possible and transfer them on. Make sure that those ED clinicians are literally just triaging them, and then making the decisions for where to go. So that's one issue there's just not enough money in the system, there's a lot of red tapes and it's really difficult to change that. I think, my impression is that in Australia, there is a bit more autonomy within the healthcare system, and there's less intervention from the government to try and meet those KPIs. It also feels like the medical bodies are more powerful, comparatively, compared to the medical bodies in the UK. So, you know, yes, we've got the KPIs, yes, we've got the near times, but we don't need to meet them as closely. In New Zealand, they talk for about six hours, anytime, six hours, so that's one example. I also think, there is just more money, I'm not an economist but, I think on the ground, I get everyone has way more money swirling around in the Australian healthcare system compared to the UK. Point and case, like when I was locumming, for example, I noticed, you know, locumming up and down the East Coast, up and down the West Coast new hospitals, they are all less than five years old. All the EDs have got four or five ultrasounds, and there's a 10th of the patients than in any UK Hospital. That is real life. Like, there's way more money going around, and ultimately, it makes you feel much less like a flogged workhorse, working here. You're more respected and you are more valued and part of that is the financial return and that quality of life return, it's important. Why do you think there is a difference? Is that an expansive question?

Benjamin Lepke 08:56

Absolutely. It's one of the reasons why Australia and New Zealand, aside from the geography and what people want to do, to kind of see the healthcare system is viewed, and quite rightly, as a place to come and work and work within due to quite a lot of those factors you just mentioned.

Dr. Yanni 09:12

Not mentioning the weather, not mentioning travel, red tape, the friction.

Benjamin Lepke 09:18

Well, moving on, let's go back to yourself then so everything that we've just discussed with some drivers for you to come to Australia. So you arrived, and you're in Newcastle, how did you get into training? What was training like? You made the decision to follow the ED pathway, how did that come about? How was the training process?

Dr. Yanni 09:39

Yeah, so I came to Australia straight into an ED job at the Calvary Mater in Newcastle, which was good. I think there were about 30 doctors that had emigrated from the UK.

Benjamin Lepke 09:50

And that is only one hospital.

Dr. Yanni 09:50

That's only for Newcastle, just for Newcastle and at the time, 2013, it was much easier to get on to the program as a UK Doctor. It was just a case of signing up, getting some references from other ED consultants and then you could get on to the pathway. I remember that the closing date was rapidly arriving, like December 2013, I only arrived in August 2013, so I basically got on pretty quickly before the closing date. Then subsequently, it's become a lot harder, you have got to do all sorts of things, and I can't keep up with that. Then I got on pretty quickly and then did my primaries in about April 2014 and it's progressed through to being a junior reg, in early 2015. In that interim, I moved from the Marter to John Hunter and then moved to Port Macquarie, for a better opportunity, to get my anaesthetics and intensive care training. Stayed there for three years, and then moved to the Sunshine Coast for my late-phase training, for my fellowship.

Benjamin Lepke 10:50

So, from Port Macquarie, did you move to do your advanced training in the Sunshine Coast then?

Dr. Yanni 10:55

No, I did my primary written in May/April 2014, I sat my viva, then I had to re-sit it again in 2015. So, I got it on the second attempt then that allowed me to basically get into that late phase, or was it the early phase? I can't remember the terms.

Benjamin Lepke 11:17

So many phases.

Dr. Yanni 11:18

So many phases and it's changing again. I basically progressed to being a reg proper in Port Macquarie and you need your anaesthetics and ICU to progress really into being a competent senior reg and it was easy to get it in Port Macquarie but yeah, I ended up staying three years there.

Benjamin Lepke 11:34

Because getting those critical care terms also opened up other doors and avenues as well in terms of opportunities.

Dr. Yanni 11:39

Absolutely it did, first and foremost, it's just that personal sense of comfort. You know, you're just a bit more reassured as an ED clinician; once you've got those skill sets, once you go onto night shifts and you can handle an airway, it's much better. It does open doors from a locumming perspective, from a senior reg jobs perspective. Pretty much as reg the second or third question that asked you is what airway skills do you have? Can we put you on night shifts?

Benjamin Lepke 12:08

Yeah. Will you work by yourself? - The main question? Well, let's segway slightly then, I've known you for a long time now and worked with you. So, let’s talk about locumming throughout your training. How was juggling locum work and training? How did you manage that? Did you take big chunks of time off to do the work? Did you do it in between? How did you manage that balance?

Dr. Yanni 12:30

How did I manage the balance?

Benjamin Lepke 12:32

How did you manage balance? Would you have done it differently?

Dr. Yanni 12:34

I managed it. I think my perspective on locumming has changed necessarily through my experience. I was perhaps ignorant and naive because I didn't really know about it initially. You know, there's a bit of a school of thought that you shouldn't be doing that, you should just focus on the pathway and just progress and not knowing any better, I probably subscribed to that a little bit but what I did find, I think it happens to a lot of trainees to be honest with you. After doing my primaries, moving around, and having some sick family members in the UK, you do get a bit of wear and tear and perhaps a bit of burnout. I did feel quite exhausted, coming into sort of 2017/18 and actually, I didn't realise I needed to take some time out. I was actually just thinking about it, it took me about three months, three to six months to think, I just need to take time out and when I did, I didn't really know how to make it happen. I didn't really know about the locumming scene that much, it was another consultant that put me onto it, put me on to you and it was actually incredibly daunting to take a year out and to locum, it was very daunting, I felt to say felt like I was failing, I felt like a failure taking a year off.

Benjamin Lepke

You felt like you weren’t progressing.

Dr. Yanni

It's ridiculous to think of it now but I was genuinely petrified of taking it initially, I was thinking six months, I was like, actually, I need to take 12 months. That's what we'll take time out, refresh, and then how do I make it happen because when you're kind of you're really privileged enough to be a doctor, your career path is laid out in front of you, and you kind of have to change gears from automatic to manual and make it all happen. So, it's daunting, but a couple of months into it like this is the best thing. This is the best decision, yes financially for sure but also from a wanderlust perspective, you know getting to see basically every state in Australia now except Canberra via work and I think it gave me a huge bump in terms of genuine acquired confidence because of being exposed to so many different looks of what, excuse my French when the shit hits the fan.

Benjamin Lepke

And who’s around to support you.

Dr. Yanni

Yeah, it exposes you time and time again to your own foibles, your own failings that are covered by the specific kind of by the system that you're in, right. So because your work keeps working in that healthcare system, the specific processes and policies and guidelines and what have you just always seem to protect you for whatever look you go into, the other side of Australia is completely different and then you realise actually I'm not, that's not good enough, I need to be way better. You do that enough times and I remember coming back to Sunshine Coast, it I just felt like a completely different, I felt like a completely different condition and I could see the response in my other consultants, they were like, "Oh, this he has grown". To come back to my initial point of my perspective and my thoughts on locumming it has changed through those experiences. Now, I'm actively encouraging people, I remember one of the very senior facems in the college and Port Macquarie, one of my DMT said to me, rather, I thought rather cryptically in 2016, before I took my year off, I've always thought about it. He said, he said, Yanni, whatever you do, you must locum and locum in as many different places as possible. I don't know if that was an observation on my, for me, maybe? Who knows? Regardless, I think it's true for most clinicians, actually, it's true for most clinicians and regrettably. You can tell when people haven't moved around because they have one, you know, they slice the one school of thought and they skin the cat. Yeah, one or two ways, and not many different ways and human beings are complicated, but I'd be able to come at it from multiple angles.

Benjamin Lepke 16:32

Absolutely. Fantastic. Well, so back refreshed, and reinvigorated, you're ready to move forward and take out the final exam. So, let's talk about return to work and then your progression up towards the written and OSCE.

Dr. Yanni: 16:47

Yeah, so returned to work in progression to written in OSCE. So, I would just make the point in that year out, it wasn't just traveling, looking around. I didn't actually I saved quite a bit of money and I spent that on exams and courses, and I did the back half of the six months. I was ramping up my studies so that was really helpful, I was sleeping normally and that helps your memory helps your capability to study as night shifts, as we all know, it just wrecks you. So, coming back into my normal training program, yeah, I basically, I had two attempts at the written and I sort of fell in that COVID timeframe where my exam was postponed, that kind of affected my timing and the energy and COVID. Anyway, narrowly missed the written. And then I went again and passed it on a second sitting and then pass the OSCE in the next sitting, yeah.

Benjamin Lepke:

Congratulations.

Dr. Yanni:

Thank you.

Benjamin Lepke 17:44

What advice would you give to people that are sat in that state of anxiety for the written and the OSCE ahead of them? Like, what did you do in part of your preparing for them, that you felt now looking back on? It was yes, that was great. I'm glad I did that.

Dr. Yanni 18:02

Yeah, I think you've got to understand yourself, I'm very wary to give one specific bit of advice if it's done right because we're so different in the way we learn, and the way we study. When I'm helping registrars, and friends go through the process and they're asking me for help, I actually just try and listen to how they approach, first and foremost to help me understand them. Hopefully, in some way, help them understand how they go about it because, by the time you get to that level, you're actually pretty good at studying. It's more about refining what you're doing to get over this last significant hump. I do think though, a lot of it is, the top two inches, a lot of it is psychological. After you've understood yourself, I think one of the key principles, everyone talks about this being a marathon. If anyone has done long-distance running, and I have actually done long-distance running. The thing that you find very quickly is how well you're recovering. It's about your self-care, it’s about your recovery, and how well you're looking after yourself, whilst maintaining your work-life balance, and your relationships. How you can maintain that so that you can use the metaphor of running to keep up that 100 K, 100 kilometers a week of running for those 52 weeks for the year and a half. It is intense, so you need to be able to recover and stay relatively fresh. I focus really hard on that aspect and how to maintain my sanity and how to avoid or not avoid burnout, but to minimise burnout so that I could maintain consistency. How do I do that? I actually cut back on my hours; I think that's quite important. Night shifts wreck you, and I think it's cumulative by the end, by the time we get to the late phase, you're not as fresh as you were when you were in PHO. I can't tell that to the PHOs coming in that really chipper like I went straight through the prac, you know, you've got a lot of energy but it's actually huge, it's cumulative.

Benjamin Lepke 19:57

It's just that intimate burnout phase.

Dr. Yanni 19:58

You do, you do but cutting back on the hours I think helped me, especially being like, on my own, single, COVID, with no family around me. Therefore, locuming was helpful doing the old shift a month because, by that time, I felt that I had enough of a base clinical, like time on the floor that I didn't need to do full time, I could go and pass my exams. I think exercise is really important, personally, I'd get up early, do something gentle in the morning, get my blood flow going, good food, breakfast, and protein it sounds so basic, but it helps. When I avoided them, I just fell and then it would just be like regimental nine o'clock, I'd be at my desk, good two, three hours, break. In the afternoon, I'd do something more like weights or something, then I do my proper home so gently in the morning, heavier in the afternoon, and then I do an evening session of study again. And then after about five, or six hours of study in that day, my next goal was to be fresh for the next day.

Benjamin Lepke 19:59

To try and get to sleep.

Dr. Yanni 20:04

To be fresh for nine o'clock the next day and, you know, saunas for me just sitting at a desk, regular massages.

Benjamin Lepke 21:15

Keeping relaxed.

Dr. Yanni 21:16

Yeah, keeping relaxed, and being kind to yourself. I would say as well, the other thing that was quite helpful, and actually a surprising number of fellow senior registrars and FACEMU's that perhaps isn't voice is psychologists.

Benjamin Lepke 21:30

Right, okay.

Dr. Yanni 21:30

Yeah. I think it's just we're just not open enough. I think but if you speak to quite a lot of registrars there's a surprising amount that uses them and it's a specific type of psychologist, a performance psychologist, and they tend to focus on elite sportsmen and doctors. They are literally the two clients, and that says a lot about the process. This is the analogy of I just kept coming back to this like a marathon and being like, an elite athlete, and looking at yourself through the prism of an athlete. So if you're an elite athlete, you've got your sports psychology, you got your nutritionist, you've got your physiotherapists, you've got your like your support team and that is what it's like heading into these exams. And for me, I really had to break it down with no support system around me and COVID and being a senior reg, but it was breaking it down that allowed me to understand how to get through it.

Benjamin Lepke 22:31

That's very interesting actually, I hadn't really considered it because it was quite like an athlete or a sports person, because you know, a track runner it’s them, they're going they are training themselves to be the best to win. Everyone else is not it's not a team sport effectively, you know, this a team with your team around you, supporting you as individuals. So, your psychologists and all that becomes your team becoming a team. It's you, yeah, effectively so, it's like building that team for yourself to help you.

Dr. Yanni 22:58

Have you had friends that are like athletes, or professional athletes?

Benjamin Lepke 23:03

I've been involved in sports. I've seen a couple of my friends, they get to a fairly high level in sports, etc. But no actual athletes

Dr. Yanni

Or professional sportsmen.

Benjamin Lepke

Not personally.

Dr. Yanni 23:13

Because it's quite interesting when you get to know them. It helps you understand, like this world. So, I remember in 2008, I did a London Marathon Guinness World Record fastest marathon dribbling a basketball. I know it was crazy, crazy.

Benjamin Lepke

Did you?

Dr. Yanni

I did, yeah, have I not tell you?

Benjamin Lepke 23:30

No, so you did a London Marathon dribbling a basketball?

Dr. Yanni

Yeah. I though told you.

Benjamin Lepke

No. I have no idea you've done that..

Dr. Yanni 23:37

You just haven't read my CV. It's just you just have not read my CV.

Benjamin Lepke

That would be close to beating in one of my favourite things on a CV, which is coming in a certain place in paper rock scissors World Championship.

Dr. Yanni

Who said that?

Benjamin Lepke 23:51

Well, someone did say that on one of their CVs at some point throughout my career, which I quite enjoyed reading.

Dr. Yanni 23:56

Oh really?

Benjamin Lepke 23:57

But I did definitely miss you doing the dribbling at the London Marathon wow.

Dr. Yanni 24:00

I did, that is more another story but what that did is it exposed me to athletes as well. So, in the London Marathon, they had a section for Guinness world record holders and we went in with the athletes. But also, around that time I did, I was doing a lot of athletics and track athlete, and one of my friends was me had a few friends. You just realised there's another level of focus, it's another level altogether. It's all fun and games with amateurs but the professionals are on another level and it's similar, it's obsessive, it's always pathological.

Benjamin Lepke 24:33

Yeah, well, you are now a FACEM. You and our fellow emergency medicine specialist. What doors are opening for you? What's ahead of you in the future at the moment?

Dr. Yanni 24:44

What doors are opening? I think, I'm going to be honest, the first thing is the sword of Damocles is no longer hanging over my head by a thin thread it's just a weight lifted.

Benjamin Lepke 25:00

You must be a humongous weight.

Dr. Yanni 25:01

There is a huge weight but no, just fellow job opportunities, obviously, financially, it's a lot more. I'm not the one paying for lots of courses and exams and getting quite five work properly now for a little bit. But you know, the world does open up, I'm going moving to Melbourne to do my fellowship role in the next few months. I hope to go potentially to London and do some hymns in the year after but also just got more bandwidth and mental space to delve into some passions I've had to keep on the back burner. For the best part of four- or five-years things like a project where we're both working on in Rwanda with yourself with 1Medical, with regards to partnering to do some charitable work and some philanthropic work with 1Medical and I guess that has, there's loads of potential avenues and directions that could potentially go. I'm working with your colleague, Ryan, and yourself to finalise a trip to Rwanda in July for three weeks.

Benjamin Lepke 26:00

Yeah, that's extremely exciting.

Dr. Yanni 26:02

I mean, that is a door that opens up. I could never.

Benjamin Lepke 26:05

You've not had time to do that.

Dr. Yanni 26:06

I can, I can think about that now.

Benjamin Lepke 26:08

You can start planning holidays.

Dr. Yanni 26:09

I can start planning holidays, I can start reading non-medical books. Oh, my God, I can start watching a Netflix episode without getting guilty all seasons, that type of stuff, but the doors have opened, I mean, I've only been a FACEM now for two, three months so the doors are open, but I'm still in the wake of feeling, what's the radio-friendly term?

Benjamin Lepke 26:09

Free?

Dr. Yanni 26:24

Free, there we go.

Benjamin Lepke 26:36

Excellent, so if any of our listeners are now junior doctors thinking about embarking on a path, you know, is there any advice you give to people? If you can talk to yourself, back at PGY4? Was there any advice that you would give?

Dr. Yanni 26:49

It's really hard to give advice that's generic for everyone.

Benjamin Lepke 26:54

Let's change that then. What would you tell yourself?

Dr. Yanni 26:56

I think that can actually be more helpful to everyone. I think to be kind to yourself, I say it a lot. Just, take it easy relax, alright it's not about smashing out incredible days just try it. I sometimes just tell some of the junior regs to try and go for 80% every day 8/10 is good enough every day, and you don't have to be 10 out of 10 because you burn yourself out real quick. Take plenty of breaks, and advocate for your own well-being because the healthcare system will take more out of you than you will out of it. Do look after yourself and advocate and be aware of limitations of your own, I guess, burnout. I read a stat, 50 to 80% of the care staff clinicians experience burnout in their career and it has many guises, it has many forms, with regards to I think it's important to have many allies. I'm a diversity and inclusion representative for ACEM, myself and two others in Australia and three others in New Zealand. I work with Claire Skinner, the college president, and the incumbent president Stephen Guney on issues relating to discrimination, bullying, and sexual harassment, as well as a diverse sort of gamut of issues relating to DNI. I think it's important to have allies, it's important to collaborate to speak and share your experiences, specifically for me, in my experience as a black doctor, in the healthcare sector, it took me a while to realise how to maneuver the space in my own skin, especially as a junior doctor. Again, being a junior doctor often means that you're also a young person, so those two things are happening at the same time and what does it mean? How do I sort of feel comfortable in my skin? Being other and different? How do I find my voice? How do I navigate what can be perceived and what can be real institutional racism? It can be very challenging, very, very, very challenging, and part of the reason why I ended up seeing a psychologist in the end. What I would say to a younger self is to listen, to be aware, and listen carefully. Don't discredit what people are saying or what you're feeling, that is often true. You can get gaslit very easily when you are othered and it may take time for you to find your voice and to find your true self but just keep plowing that and keep pushing forward in that direction. Use friends you got to crack at some eggs to make omelets. You do have to trust people and that can be hard when you feel othered and yeah, just be kind to yourself.

Benjamin Lepke 29:36

Be kind to yourself, the resonating point behind, throughout this conversation.

Dr. Yanni 29:40

I can't agree more, be kind to yourself. It is brutal you know, it's a difficult career being a senior reg in an emergency, I think is one of the most difficult jobs in the hospital. It's one of those and on top of that you're doing the fellowship exam and on top of that, you're moving this, that and trying to support yourself doing that locumming, you're doing night shifts. It fries, your nervous system, be kind to yourself.

Benjamin Lepke 30:02

On all of that, final point, tell me the feeling of when you open that email and you had a pass mark, to make all of what you just said worth it. Can you even explain that feeling?

Dr. Yanni 30:12

For those not watching, I'm taking a deep breath. It was emotional, it was deeply emotional, it was very sort of still, the peace it was. I opened it, but I actually didn't, I just sat there for an hour before I opened it. I opened it on my own, it was raining, and I was in Mooloolaba by Mooloolaba Beach on the sunny coast and opened it. They have this, you open the email, and it's a notification with a red cross and three lines, so the first thing you see is the red cross. But that's just the notification. It's like, once you read the notification, you press the red cross, but yeah, big red cross. So, like, one more blow but it was very validating, very relieved. I think the initial one of the initial feelings is like the absence of that pain, that worry. That's the joy that comes but it's the absence of it best and then the joy takes a while to come.

Benjamin Lepke 30:45

Because you realise, it finally breaks through.

Dr. Yanni 31:25

You're no longer pushing against, that's no longer defining you, because it defines you for like, three, four years. I describe it to one of my friends who one of my Vascular consultant friends who passed his exam in the UK, it's like you're in a rocket ship, and you're at peak velocity trying to break through the final atmosphere, and you're just hurdling for years and finally you break through into space.

Benjamin Lepke

It’s serenity.

Dr. Yanni

And it's like, what do I do? That's what it feels like.

Benjamin Lepke 31:54

Excellent.

Dr. Yanni 31:55

I hope it didn't sound too dreary and negative; it is good. And it's not all bad it's just you've got to have your wits about it, you got to be smart. You got to buck smart, you've got to seek a lot of advice from different people, think carefully, about how it's going to work for you, and reflect a lot. There's a lot of like, self-reflective work that, you know, you're asked to do as part of your CPD. And I think you see the use of it as you progress, but I would urge people to reflect early on, think carefully, but reflect continuously on every interaction, especially if it feels wrong, or it feels like you can't quite put it, put your finger on it.

Benjamin Lepke 32:33

That's a very important point that, in all walks of life. I actually do that in here, with the team and the junior consultants I have, I tell people to reflect on conversations. So, you know, active listening that we do, but you're actively understanding what's happening and if something doesn't go in the direction you're expecting, it reflect and go, well, where was the breaking point? How did that happen? Where did that? How did I end up here, you analyse that part and think about how you could do that differently. Without reflection, you would then just potentially meander on and make that mistake again. But if you do self-reflect, it's an extremely powerful tool.

Dr. Yanni 33:06

There's not enough lessons, there's not enough pages in a textbook that they give you a medical school to give you the lessons that you need to learn to progress in business or in medicine. I would ask you one question, from your vantage point, what I want to ask the same question you asked me but sort of from your vantage point. So, what do you think are the lessons learned, the pointers you would give to someone starting off in emergency medicine in Australia, to progress through the training program and to make it to become a FACEM? Because you interact with a lot, you've got many doctors.

Benjamin Lepke 33:41

I do, I've spoken to hundreds, thousands of doctors throughout my career.

Dr. Yanni 33:46

I think your perspective is interesting as well.

Benjamin Lepke 33:48

Yeah, my perspective is the same as yours, to be honest. But I saw I didn't have to find it, I just knew it. And what I mean by that is, is that I'm not a doctor, I'm not medically trained however, upon speaking with thousands of doctors, and I only ever talk to emergency medicine-trained doctors, I do find that a varied career and work experience, whether that may be full-time all the way through or indeed locum work, working in different hospitals, different settings, rural and remote, regional, etc. however, it may be, different states because different states practice differently as well. Getting out there, I tend to find gives doctors a lot more confidence, which then I find from speaking to them that they tend to progress better throughout the course of the fellowship, etc. because they do house that confidence. They have, as you were saying before that breadth of knowledge and experience, and they've been put in difficult situations and they've been put outside their comfort zone and they've managed to deal with it. Importantly, they've learned about themselves they've learned that yes, I can actually do this because as we all know the exams for the emergency medicine college and fellowship are extremely daunting. So, you can't not of put yourself severely outside your comfort zone multiple times before that and with the hope of getting past it. So, I find that having a varied career in terms of emergency medicine, I do find that doctors who take the old the six to twelve months out, what that also does is it relieves quite a lot of stress in the personal life, mostly financial. So, like you did, you started to get burnout. I've personally burnt out myself, I'm not a doctor, I've burnt out in recruitment, and I sprinted for 10 years and then fell off, fell sideways. I then took time off and I travelled the world, and then came back and started again is exactly the same thing. You're sprinting from university all the way up to becoming a reg, you know, you're talking nine years, eight, nine years?

Dr. Yanni 35:49

Through uni as well for me.

Benjamin Lepke 35:51

Yeah, exactly. So you've got all of that don't be scared of taking that six to twelve months out, and then you enter it back in refreshed, less debts, seen the country you've made sure you want to do ED. More importantly, you've made sure you want to know where you want to live for the next three or four years while you train and you've learned more about yourself and then you enter the new stage of confidence.

Dr. Yanni 36:13

Some things require it's a bit like that, you know, podcasts, the long form conversations become really popular across the world, because some conversations, be it with yourself or with other people, just require a long form and time to breathe. You know, that's why taking that time allows part of your own self to just marinate and just, without having to do a night shift on Thursday. You know, and just to be, it's really healthy, I think.

Benjamin Lepke 36:41

Yeah absolutely.

Dr. Yanni 36:43

Agreed.

Benjamin Lepke 36:43

Brilliant. Well, thank you very much for your time.

Dr. Yanni 36:46

No, thank you.

Benjamin Lepke 36:47

I look forward to working with you, moving forward as you mentioned, the charitable piece for Rwanda, which we'll be discussing in a lot more detail when people find out about it.

Dr. Yanni 36:56

TBC, to be confirmed.

Benjamin Lepke 36:58

Indeed, so have a great day.

Dr. Yanni 37:00

Likewise, more locum paperwork to do now.

Benjamin Lepke 37:04

You need to give me all your documents. Cheers, buddy.

Dr. Yanni 37:07

Thank you.

Benjamin Lepke 37:08

Thank you. Bye bye