Tomorrow, after three years as Chair and three years as Deputy Chair, my time as an officer of the UK Junior Doctors Committee @TheBMA comes to an end. It has been a privilege to represent colleagues throughout what has been an incredibly turbulent time for the profession.

I had my RSV vaccine today! 💉💪 As a paediatric SpR, I'm delighted that it is now available to protect infants against bronchiolitis. RSV causes so many admissions over the winter months. If you are in third trimester of pregnancy, ask your midwife about getting the vaccine!

Feedback from students - "you don't know it til you live it" (and some of the top exam results from those in the scheme) From teachers - better doctor when students present, renewed enthusiasm From the community - "it takes a community to train a future physician" #DEMEC23

Emphasis on immersion in communities, e.g. through longitudinal integrated GP clerkships - students are motivated to learn as seeing patients as part of the team, and learning is multilayered through different contexts and contacts. #DEMEC23

Plenary from Prof @RogerStrasser on how socially accountable medical training addresses inequities in rural and underserviced communities. Hidden curriculum assumptions - cities have prestige, rural work is somehow inferior. #DEMEC23

Great project at @BucksHealthcare on ensuring self-development time (SDT) for all junior doctors (not just FYs, which is mandated from national level employers). They made it work, on the whole, despite some challenges. I asked likelihood of national backing - case studies help.

Out of programme pause was initially discussed as working towards true "step on step off" training as part of individualised training pathways. Hopeful that this is slowly coming to fruition! It should be possible imo without needing a reason, given enough notice.

(Also an interesting question about whether for increasing numbers of applicants, geography matters more than specialty?)

One thing we tried very hard to do with MDRS about 6 yrs ago, unsuccessfully, was linking applications across specialties & geographies. The scoring systems just didn't work, so instead added Enhanced Preferencing. Good to hear there's a plan to have another crack now! #DEMEC23

Special circumstances for recruitment, Cat 3 LTFT training, SuppoRTT, person specs having less emphasis on paid courses, out of programme pause, flexible portfolio training, study budget reform, IDT reform - all came through this group (via other groups too but overseen by EJDWL)

Next: update on Enhancing (Junior) Doctors Working Lives. I was part of this group for several years from shortly after its inception; of all the programmes I was a rep to in my BMA roles, it was one of the most progressive and forward thinking. #DEMEC23

Question of the day for me - we need to look again at the aims of our postgrad written assessments... Knowledge acquisition or rites of passage? #meded #medtwitter #DEMEC23 (Also, welcome back to Twitter, Sarah!)

Or does it not matter, because we suspect human doctors will take the tested exam knowledge, then apply the context and meaning anyway, in a way that A.I. cannot? 🤔 #DEMEC23

I'm musing essentially on whether we should also (/instead??) be testing application of that knowledge - the step where we apply meaning. Or is that where the other parts of training programme assessment come in? (Your WBPAs if done properly for example). #DEMEC23

Interesting that these AI programmes were able to pass medical exams, and yet that knowledge is not enough to work in medicine (indeed doctors ignore AI outputs in studies ...) *Meaning* is important. But also: what does this mean re: what our exams are testing? #DEMEC23

I'm obv biased - as Deputy Chair and then Chair of UKJDC I worked with stakeholders on category 3 LTFT (and indeed was persistent on wanting faster rollout). I personally also feel the answer to many of the issues is more doctors - recognising there's no overnight fix with that.

So the question posed: how do you make it work? This is what the room at @DEMEC23 suggested as priorities for trainees and employers #DEMEC23 (... some controversy here IMHO)

And feedback from those managing programmes. Reporting challenges and frustrations associated with the increase in flexibilities in recent years. #DEMEC23

Hearing from trainees about the positives of LTFT training (you can probably imagine) and now the negatives - rota/payroll/HR issues, expectation to do audit etc work on ltft days, jobs being allocated later, feeling out of touch with the workplace, missing certain training days.

Workshop on a subject I'm very passionate about with an intriguing title: "Could flexibility be forced into rigidity?" I'm convinced of the benefits of flexibility so I'm keen to discuss this further. (First poll is ... interesting...) #DEMEC23 @DEMEC23

Brief return to twitter for #DEMEC23. (Threads still needs to up its game to be a useful platform for conferences like this...) Looking forward to a busy few days of education and training policy! Say hi if you see me around 👋