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IntroductionThe National Health Service Long Term Plan recognises that excellent quality care requires great leadership. Understanding junior doctor experiences of leadership development can inform organisations to improve trainee leadership skills.MethodsA survey of South West (SW) England trainees was conducted to capture views on leadership and management training.ResultsResults came from 190 trainees across both SW deaneries, areas of practice and all training stages. Respondents agreed that leadership skills are important for doctors (n=186; 99%). Lack of time was indicated as a barrier to developing leadership skills (n=139; 75.5%). Audits and quality improvement projects were used for developing leadership skills. Colleagues were the main source of support.DiscussionSW trainees recognise the importance of developing leadership skills, underlining the need to prioritise opportunities for leadership development. Respondents had ideas to improve areas of practice, where ideas were supported, they were implemented.ConclusionCompared with national findings SW trainee experiences are positive, with more ideas implemented, more time for developing skills and more resources used. Activities engaged in closely aligned to the 70:20:10 model of leadership. Trainees should be encouraged to access support from peers and create networks of opportunity. Additional research in this area is needed.

Background When the COVID-19 pandemic was announced by the World Health Organisation on 11/03/2020, hospitals quickly began preparing for the potential impact on healthcare. During this crisis multi-professional teams across the NHS developed and implemented new models of service at pace. Aims In times of crisis there can be tendency to first panic and then forget. As doctors and clinical leaders in training, utilising this as a learning experience is vital. We propose a phased learning model to reflect on this unprecedented period with the aim of strengthening our leadership skills. Method The proposed ‘leadership time capsule’ is a continuous reflective process rather than a single stand-alone exercise enabling the user to learn from the pandemic as we move forward but also look back on the crisis and reflect in the moment. This learning tool is aimed for trainees and consists of five phases; Reflection, Consolidation, Growth, Embedding, and Evaluation. Integral to the time capsule are signposts to resources and toolkits. As leadership fellows, we have piloted the capsule reflecting on four different trainee perspectives: Impact on training Redeployment Telemedicine Remote working Discussion This tool provides a template for reflective practise on our experience, realising and sharing the lessons that have been learnt. As a group of fellows, this tool was used as a ‘shared experience’ process exploring leadership in our various environments, learning from our experiences and realising how we can develop as leaders going forward. This reflective time capsule highlights the importance of learning from significant challenges faced during the pandemic. Conclusion Active participation in the leadership time capsule facilitates the process of building on experiential learning during a crisis. Critical lessons from this process can inform trainee leadership development to ensure competences and confidence when facing future challenges.

Introduction All doctors in training should be exposed to appropriate leadership developmental opportunities throughout their training in line with the GMC Generic Professional Capabilities framework. Leadership learning is a process of participation in increasingly complex and personally informative tasks rather than just acquisition of a pre-determined set of knowledge and skills. As part of the 70:20:10 model of leadership development we need to move learning from the classroom into the workplace providing leadership initiatives and development at every level of training. Intervention Health Education England South West developed a Clinical Leadership Mentor (CLM) programme in 2018. The CLM is responsible for overseeing the process and progress of leadership development amongst the trainees of their Trust, creating a portfolio of leadership and management development in partnership with other stakeholders. Strategy for Improvement CLMs required funding, support, development, and network opportunities. Financial support for 2 year pilot across all 19 Trusts in the South West supported by Regional Director HEE-SW with annual report by each CLM; achievements aligned against measured outcomes of key responsibilities. CLM network and developmental days with regional NHS Leadership Academy (NHSLA). Annual reports collated and shared within CLM network and HEE-SW. Sponsored evaluation of CLM by the NHSLA conducted by the University of Birmingham (UoB) Impact Formal evaluation (UoB) was encouraging; CLM role perceptions were positive and appreciated by trainees and Educational Supervisors alike. Medical Managers were also committed to the role. Excellent CLM network developed across HEE-SW. Outstanding achievements in the annual reports enabled funding secured for third year. CLM development publicised as an area of Good Practice - Leads Leadership Webinar #Leadersaloud.

Introduction The inaugural South West leadership conference, ‘Next Generation Leaders’, was held in March 2019. This was open to 200 trainees and was jointly organised by the seven Health Education England South West (HEE-SW) Leadership Fellows and two Academic Foundation doctors. It was funded by HEE-SW through the Severn deanery in collaboration with the Leadership Academy. Issue The importance of good leadership skills in junior doctors is increasingly recognised; this conference aimed to inspire and equip clinicians with leadership skills. Topics included exploring leadership during challenging circumstances, leadership development, human factors and organisational structures. We adopted a distributive leadership approach, rapidly learning how to organise and promote a conference in budget, inviting speakers, providing network opportunities, website design and coordinating poster presentations. Intervention The conference delivered a varied programme with full details available at the event website (www.nextgenerationleaders.net). A diverse range of speakers were invited from within healthcare and other industries. We aimed for total inclusivity for all trainees across the South West, being free to access, central location and flexible content. Measurement Feedback from delegates was obtained via an electronic survey. Analysis showed the conference was well received, 98% of attendees recommended the conference. Lessons Reflections of the organising committee centred around how we worked as a team, bonding at the start of the fellowship and becoming a cohesive group. Through our individual and collective experiences this conference has acted as a catalyst to furthering our own leadership development inspiring us to pursue future opportunities. We would like to inform and inspire others interested in organising similar events. We hope to promote others to seek out leadership development opportunities, which is crucial for the future of the NHS.

International audience; Fgf-3 is expressed in a complex pattern during mouse development. Previously, an essential regulatory element PS4A was identified in the promoter region, and shown to bind at least three factors. To identify the transcription factor(s), we used a yeast one-hybrid screen and obtained a novel Sox6 cDNA (SOX6D). When introduced into cells it strongly repressed activity from both an Fgf-3 reporter gene as well as an artificial promoter containing three PS4A elements. In situ hybridisation analysis showed that Sox6 and Fgf-3 are co-expressed in the otic vesicle of E9.5 mouse embryos in a mutually exclusive pattern, consistent with a repression of Fgf-3 transcription by SOX6. To characterise additional factor(s) involved in Fgf-3 gene repression, a yeast two-hybrid screen was used with the N-terminal portion of SOX6D. Mouse CtBP2 cDNA clones were isolated and shown to bind SOX6 in yeast and mammalian cells. Furthermore, mutational analysis of SOX6 showed that binding to CtBP2, and its responsiveness to this co-repressor, were dependent on a short amino acid sequence motif PLNLSS. Co-expression studies in NIH3T3 cells showed that SOX6 and CtBP2 co-operate to repress activity from the Fgf-3 promoter through the enhancer element PS4A. These results show that SOX6 can recruit CtBP2 to repress transcription from the Fgf-3 promoter.

fgf-3 shows a complex spatial-temporal pattern of transcription during mouse development, and the gene product appears to be an important intercellular signaling molecule. Here we show that the major enhancer, which is obligatory for transcription, is composed of three elements with different properties. Both functional analyses in undifferentiated and differentiated F9 cells and characterization of DNA-protein complexes in vitro have identified the sequence motifs GTGACT(C), ATTGT, and GATA as the key transcription factor binding sites. The GTGACT(C) motif, while not essential, is required for full enhancer activity. However, binding at ATTGT is crucial for transcriptional activity and is required for cooperative binding at the proximal GATA site. The GATA binding site mediates the retinoic acid/dibutyryl cyclic AMP stimulation of transcription and correlates with the binding of Gata-4 which is induced by retinoic acid in differentiating F9 cells. The ATTGT and GATA motifs are inactive when placed separately on a minimal thymidine kinase (TK) promoter, but together they act as a strong retinoic acid-regulated enhancer. In undifferentiated F9 cells, gata-4 expression stimulates the fgf-3 promoter, whereas in differentiated F9 cells already expressing gata-4, no further increase in promoter activity was observed.

The proto-oncogene Fgf-3 has been implicated as an important signalling molecule in vertebrate development. In the mouse, it is expressed for a limited time at a multitude of sites from embryonic day 7 to birth. Transcription of Fgf-3 initiates at three promoter regions resulting in the generation of various mRNAs which nevertheless all encode the same protein products. A 1.7kb DNA fragment which encompasses these regions was joined to the CAT reporter gene and shown to function as a promoter in embryonal carcinoma cells. In stable transfectants the promoter retains its retinoic acid inducibility, initiating transcription at the same cap-sites as the endogenous gene. In differentiated F9 cells, transient transfection of progressive and targeted deletion mutants of the promoter region has revealed at least two positive and three negative regulatory elements. With one exception, loss of these elements was shown to dramatically affect promoter activity in stable transfectants of F9 cells. However the promoter remained inducible by retinoic acid to differing degrees, apart from deletions encompassing PS-4A which essentially abolished promoter activity in both undifferentiated and differentiated cells. The sequences of these potential regulatory regions were further defined using DNase-I footprinting, revealing some similarities to consensus binding sites for known transcription factors.

Acute hantavirus infection was diagnosed in a young man presenting with a hypersensitivity vasculitis and arthropathy. He has recovered with minimal evidence of residual renal damage.