1 00:00:01,520 --> 00:00:05,510 Tim: When you're new to working in an emergency room, it's hard to avoid getting 2 00:00:05,540 --> 00:00:10,910 overwhelmed by the cognitive overload of a continual stream of patient after patient. 3 00:00:11,360 --> 00:00:14,120 Device after device and beep after beep.. 4 00:00:15,596 --> 00:00:17,096 This episode follows 5 00:00:17,096 --> 00:00:20,876 Dr. Carolyn Morton's career from medical doctor to software engineer. 6 00:00:21,626 --> 00:00:29,686 It's a fascinating story that involves learning to code, learning Rust, starting a company, starting a new career, and 7 00:00:29,706 --> 00:00:33,476 having the ambition and determination to know that it's the right thing to do. 8 00:00:34,476 --> 00:00:35,546 Caroline Morton: Uh, yeah, brilliant. 9 00:00:35,576 --> 00:00:38,126 Um, so I am running a company. 10 00:00:38,176 --> 00:00:41,576 It's called Yellowbird Consulting, but it's soon to be Clinical Metrics. 11 00:00:41,766 --> 00:00:47,456 It's a medical simulation platform, um, and the back end is built in Rust. 12 00:00:47,886 --> 00:00:50,926 What it essentially is, is a virtual emergency room. 13 00:00:50,936 --> 00:00:52,306 So, um, I've. 14 00:00:52,691 --> 00:01:01,151 Well, we've created a way to make an unlimited amount of virtual patients that are based on the underlying epidemiology features of- 15 00:01:01,261 --> 00:01:06,926 We've got currently 52 diseases in it and patients arrive. 16 00:01:06,986 --> 00:01:12,966 You start with three, and then they just keep on arriving, much like real life, except you'd never start with just three. 17 00:01:13,316 --> 00:01:16,896 And you have to take a history from a chatbot. 18 00:01:17,286 --> 00:01:22,996 You can order any investigation, that you might want to in a real emergency room. 19 00:01:23,326 --> 00:01:26,366 You can order blood tests, you have to wait for them to come back. 20 00:01:26,605 --> 00:01:27,606 Writing notes. 21 00:01:27,896 --> 00:01:36,906 The aim of the product is to improve clinical reasoning, but it's also to test the cognitive load and to really train people about that 22 00:01:36,906 --> 00:01:43,976 cognitive load, which I found in my experience is just not well taught or, um, it's not even taught. 23 00:01:44,006 --> 00:01:52,046 It's like experienced as a junior doctor or as a, as a medical student in particular, where it's not just one patient at a time. 24 00:01:53,291 --> 00:01:57,151 You have to, you have to think, Oh, I've got a, this patient, they're here. 25 00:01:57,191 --> 00:01:59,731 I've got to remember to chase the bloods for this other person. 26 00:01:59,981 --> 00:02:01,781 Or this person I've sent for an x-ray. 27 00:02:01,801 --> 00:02:06,201 And you've got to be able to keep it all in your mind and develop systems that you can keep track of everything. 28 00:02:06,421 --> 00:02:09,441 And to be honest, that's, what's really challenging when you're a 29 00:02:09,441 --> 00:02:14,661 junior doctor is not necessarily that the content is so crazy difficult. 30 00:02:14,701 --> 00:02:18,961 It's the cognitive load of trying to remember all of the things you must do. 31 00:02:20,231 --> 00:02:25,351 Tim: Do you also integrate aspects like, Oh, the Charge Nurse is like demanding something, 32 00:02:25,401 --> 00:02:31,201 or the human dynamics of essentially being in ED and being distracted, or like someone, 33 00:02:31,701 --> 00:02:33,771 Like, my experience as a patient. 34 00:02:33,771 --> 00:02:39,601 So, um, I happened to spend several hours at our ED with my girls. 35 00:02:39,601 --> 00:02:46,381 My, um, uh, my six year old is asthmatic and, um, and I've also come off a mountain bike a few times. 36 00:02:46,531 --> 00:02:49,651 And so I. 37 00:02:50,316 --> 00:02:59,816 I'm aware of the kind of when you're stuck in the waiting room, you spend a lot of time observing the practice, or at least I do. 38 00:03:00,416 --> 00:03:09,116 And, um, yeah, and I have both sympathy and extremely high regard for, uh, doctors in an 39 00:03:09,116 --> 00:03:16,971 emergency room because, um, Essentially [it] is just a large series of difficult choices. 40 00:03:16,981 --> 00:03:18,731 At least that's what it seems to me. 41 00:03:19,771 --> 00:03:20,591 Is that accurate? 42 00:03:21,341 --> 00:03:23,891 Caroline Morton: I don't, I wouldn't say necessarily that they're difficult 43 00:03:23,891 --> 00:03:28,161 choices because a lot of it is protocolized, so, you know, there is... 44 00:03:28,171 --> 00:03:28,891 Tim: No, right, right, right. 45 00:03:29,611 --> 00:03:33,261 Caroline Morton: That you do, but it's, you know, I think it's the volume. 46 00:03:33,291 --> 00:03:35,041 There's definitely a volume problem. 47 00:03:36,696 --> 00:03:43,396 You're also managing not only people's like physical health complaints, you're also trying to like manage their emotions of 48 00:03:43,966 --> 00:03:48,706 they're frustrated, or they're drunk, or you know, there's all sorts of problems. 49 00:03:49,446 --> 00:03:49,866 And also... 50 00:03:49,911 --> 00:03:51,591 Tim: They're sore and tired and... 51 00:03:52,386 --> 00:03:52,846 Caroline Morton: Yeah. 52 00:03:53,731 --> 00:04:04,461 Tim: Totally it's, um, it's, and would you imagine a junior doctor essentially playing? 53 00:04:05,501 --> 00:04:08,141 Their free time Is that the, 54 00:04:08,936 --> 00:04:09,436 Caroline Morton: Yeah. 55 00:04:09,701 --> 00:04:11,681 Tim: this essentially a game like 56 00:04:12,186 --> 00:04:12,976 Caroline Morton: Yeah, it's a gamification. 57 00:04:12,976 --> 00:04:13,816 Tim: Sim for example? 58 00:04:14,661 --> 00:04:14,961 Okay. 59 00:04:15,596 --> 00:04:16,596 Caroline Morton: It's a gamification. 60 00:04:16,606 --> 00:04:23,206 So we're in two medical schools in Germany at the moment, hoping to expand to the UK, maybe the US market. 61 00:04:23,466 --> 00:04:31,296 I've just taken the leap to go full time on the company, having run it part time for four years, with, two other co founders, 62 00:04:31,406 --> 00:04:34,836 including Maxwell Fliton, who you know, he's quite big in the Rust community. 63 00:04:35,396 --> 00:04:42,666 Um, and we, yeah, so we just, we've taken the leap, uh, going to try and move it into the UK market. 64 00:04:43,066 --> 00:04:47,646 But in Germany, the way that it's, it's used is it's embedded within the curriculum. 65 00:04:47,656 --> 00:04:55,631 So, um, they have a slightly different system to, I know the New Zealand system is quite similar to UK, but in, Germany, they seem to have 66 00:04:55,671 --> 00:05:02,051 these very quite long terms where you might do cardiology and you have teaching at the same time. 67 00:05:02,351 --> 00:05:08,401 You might have cardiology lectures at the same time that you're also going to the cardiology ward So it's in a way more 68 00:05:08,511 --> 00:05:20,811 Tim: So that, that is, if you're going through becoming an emergency specialist, that pathway is quite different, is that what you're saying? 69 00:05:21,171 --> 00:05:22,691 Caroline Morton: Yeah, it's really different in Germany. 70 00:05:22,731 --> 00:05:24,511 At least this is my understanding. 71 00:05:24,581 --> 00:05:29,681 So, with the medical schools, they might have, the way that it's used right 72 00:05:29,681 --> 00:05:36,551 now is, or our tool, Clinical Metrics, is that they, they do it every week. 73 00:05:37,211 --> 00:05:46,711 And, um, over like, say, six weeks or eight weeks, and at the same time they're receiving lectures on, you know, various heart conditions, say if 74 00:05:46,711 --> 00:05:51,601 they're doing cardiology, so they might see lots of cardiology patients within our simulation. 75 00:05:51,981 --> 00:05:56,801 Um, but they don't, at least this is my understanding, they don't really 76 00:05:56,801 --> 00:06:00,981 have emergency medicine as its own specialty in the same way that we do. 77 00:06:01,211 --> 00:06:02,751 We have it in the UK. 78 00:06:02,751 --> 00:06:07,951 It's like you're, you're a, I know you're a respiratory doctor and, but you work in the emergency room. 79 00:06:07,951 --> 00:06:08,781 So it is, there's 80 00:06:08,841 --> 00:06:10,021 slight variations. 81 00:06:12,341 --> 00:06:12,551 Tim: Yeah. 82 00:06:12,551 --> 00:06:13,511 And I, I, I assume- 83 00:06:14,331 --> 00:06:27,011 there are both cultural and, uh, practical, sorry, like the, the pathways must be quite different for how we train doctors, you know, the must be 84 00:06:27,011 --> 00:06:35,071 quite different all across the world, or I guess there are probably similarities, but yeah, I, there's also, I happen to know this because I, 85 00:06:35,431 --> 00:06:42,631 did pre hospital emergency care, the essentially the start of ambulance training a while ago. 86 00:06:42,801 --> 00:06:52,081 And, uh, the thing that was really interested me was that on the continent, there is 87 00:06:52,081 --> 00:06:56,281 much more onsite care, uh, if you're very, very serious, if you're very hurt. 88 00:06:56,641 --> 00:07:04,031 Uh, whereas the other philosophy is that you basically scoop and run and you try to get to the hospital as quickly as possible. 89 00:07:04,051 --> 00:07:10,481 Like especially for, uh, let's say trauma patients, you know, there's kind of the big debate whether or not you kind of patch. 90 00:07:11,166 --> 00:07:14,716 on site or you kind of pick them up and get them to the hospital, get them to ED. 91 00:07:15,216 --> 00:07:16,556 Um, anyway, it's probably, 92 00:07:16,941 --> 00:07:17,991 Caroline Morton: Stay and play, isn't it? 93 00:07:18,001 --> 00:07:20,011 Stay and play or run like scoop and run. 94 00:07:21,096 --> 00:07:23,646 Tim: Yeah, yeah, I don't actually remember any of the terms anymore. 95 00:07:23,676 --> 00:07:32,936 I should, um, but at one point, yeah, I was, I was, uh, an aspirational, uh, ambulance volunteer, but, um, the 96 00:07:35,761 --> 00:07:40,921 Uh, however, so I'm, I'm kind of inherently kind of interested in this, 97 00:07:41,021 --> 00:07:49,671 But, um, the thing that I'm curious about, like more from, I guess, the Rust perspective is why would you pick kind of a crazy, 98 00:07:49,671 --> 00:07:56,741 difficult programming language to implement something which could be probably implemented in something that is much more conventional? 99 00:07:56,741 --> 00:07:57,281 Mm 100 00:07:57,906 --> 00:08:00,586 Caroline Morton: Oh, well, it's gone through various iterations. 101 00:08:00,596 --> 00:08:03,736 So it actually started initially with a Python back end. 102 00:08:04,176 --> 00:08:08,826 Um, and a, what did we, I think we had a React app to start with. 103 00:08:08,836 --> 00:08:15,446 So Python back, uh, Python microservices back end and a, uh, React app. 104 00:08:15,906 --> 00:08:19,146 Um, which, you know, that was like the first, first year. 105 00:08:19,371 --> 00:08:25,111 Um, I wouldn't say we didn't know what we were doing, but we were, you know, kind of, we 106 00:08:25,111 --> 00:08:30,151 didn't really realize it was going to become the business that it has become, if that makes sense. 107 00:08:30,151 --> 00:08:33,231 I always say that we sort of accidentally set up a company. 108 00:08:33,331 --> 00:08:35,061 It was very much a side project. 109 00:08:35,401 --> 00:08:43,951 Me and Max were really into Python at the time, um, and, yeah, and so, and then, you know, two things happened at the same time. 110 00:08:44,161 --> 00:08:49,961 One, Max, who's the other business partner, um, he was getting really into Rust. 111 00:08:49,961 --> 00:08:52,181 He was writing this Rust and web programming. 112 00:08:52,231 --> 00:08:56,381 I was quite reluctant initially to learn Rust because I just didn't feel that 113 00:08:56,381 --> 00:09:02,301 I had a hugely solid grasp on Python and I was also like, a junior doctor. 114 00:09:02,441 --> 00:09:09,441 So it was, I was like trying to manage various different, I was trying to finish my postgraduate exams and COVID was also happening. 115 00:09:09,471 --> 00:09:19,031 Um, so it was, it was kind of a busy time, but essentially we, the sort of final thing which happened was we went into production. 116 00:09:19,351 --> 00:09:26,951 We have this chatbot where you have, you know, up to three patients, per student, and you might have, say, 120 students in a class. 117 00:09:27,331 --> 00:09:30,591 What happens at the start of the class is they all log in at the same time. 118 00:09:30,591 --> 00:09:34,821 So you've got this five minute window where the server's getting absolutely smashed. 119 00:09:35,281 --> 00:09:40,971 And, uh, basically it fell over in a pretty major way. 120 00:09:41,001 --> 00:09:43,091 The first time we used it, um, 121 00:09:43,331 --> 00:09:45,551 Tim: Right, and sort of quote in anger or what have you. 122 00:09:46,626 --> 00:09:50,226 Caroline Morton: Well, it just, it just, well, we sort of initially didn't know what was going. 123 00:09:50,226 --> 00:09:55,686 It just like the sort of user experience was, it got really slow, but luckily we had lots of metrics on the backend. 124 00:09:55,686 --> 00:10:00,006 We've got this amazing DevOps engineer, um, who helps us, Harry. 125 00:10:00,066 --> 00:10:06,746 And, um, so we're able to pinpoint it was coming from the chatbot and essentially we just started ripping stuff out of the Python 126 00:10:06,756 --> 00:10:12,706 backend and turning them into Rust until we just had the skeleton of the sort of Python. 127 00:10:12,876 --> 00:10:15,366 It was more like an orchestration server in the end. 128 00:10:15,376 --> 00:10:15,996 It just like sent. 129 00:10:16,571 --> 00:10:22,961 Stuff out to various Rust microservices, and then we've just switched over to Rust, completely. 130 00:10:23,361 --> 00:10:27,721 I'm not sure I'll ever write a sort of big project in Python again. 131 00:10:28,101 --> 00:10:33,371 Um, I still love it for various things, you know, like more fancy scripting. 132 00:10:34,061 --> 00:10:36,496 But, yeah, Rust is yeah, it's amazing. 133 00:10:37,656 --> 00:10:39,426 So that, that, that's really our origin story. 134 00:10:39,426 --> 00:10:41,396 It wasn't, you know, the sexiest of 135 00:10:41,451 --> 00:10:43,291 Tim: No, no, I assumed, like, 136 00:10:43,426 --> 00:10:44,296 Caroline Morton: sort of just need to move to 137 00:10:44,401 --> 00:10:54,079 Tim: It is interesting to hear that essentially you kind of , We're forced to choose something, you know, like essentially 138 00:10:54,459 --> 00:10:58,169 the application had reached its limits and whether or not it was, you know, there'd 139 00:10:58,169 --> 00:11:03,699 be people screaming at us, um, through the headphones saying, Oh, it was the suit. 140 00:11:03,749 --> 00:11:05,299 It was the architecture. 141 00:11:05,649 --> 00:11:06,229 Da da da da. 142 00:11:06,229 --> 00:11:11,769 Maybe it was this, it was that, you know, nothing should fall over with 120 people, da da da da da, whatever. 143 00:11:12,339 --> 00:11:17,749 Ignore them because in practice, what you decided to do is say, look, we've hit the limits. 144 00:11:19,439 --> 00:11:22,419 Now we're essentially forced to try something else. 145 00:11:23,439 --> 00:11:34,399 And I think it's really nice to hear that Rust and, uh, it's community hopefully was accessible enough to enable you to. 146 00:11:35,694 --> 00:11:44,134 Kind of get going, even as quote, not a, let's say expert Python developer or what have you, because by the way, you've got this entire 147 00:11:44,134 --> 00:11:55,324 other career that very soon within 24 months, you're kind of waving goodbye to, at least that's my perception of what happens next. 148 00:11:55,374 --> 00:11:56,364 Is that correct? 149 00:11:56,989 --> 00:12:01,329 Caroline Morton: So just with the, the 120 users, I just, just to go back to 150 00:12:01,329 --> 00:12:05,719 that, um, we, so we did have a, we, it was all running on a Kubernetes cluster. 151 00:12:05,719 --> 00:12:11,979 So we, our initial sort of patching problem or patch was that we massively scaled. 152 00:12:12,619 --> 00:12:13,219 The servers. 153 00:12:13,229 --> 00:12:20,909 So when we knew we were going to have a class, we just, you know, went up from say like three nodes to like eight nodes, spun up loads of pods. 154 00:12:20,989 --> 00:12:24,639 And, uh, I had to learn how to do that, which was really interesting. 155 00:12:24,639 --> 00:12:27,129 So like essentially like really scaling it, which did. 156 00:12:27,744 --> 00:12:29,254 alleviate a lot of the pain. 157 00:12:29,634 --> 00:12:33,864 The problem is if you're a tiny like startup is paying for it. 158 00:12:35,184 --> 00:12:35,994 Tim: Yeah, it's awful. 159 00:12:36,464 --> 00:12:39,944 Caroline Morton: yeah, so it was like, yeah, this, this might solve our problem. 160 00:12:40,214 --> 00:12:43,084 And we did some stuff where we, we made the chatbots overnight. 161 00:12:43,124 --> 00:12:48,954 We like cached them in, in what do we, I think Redis, can't remember, but we cached them. 162 00:12:48,974 --> 00:12:52,474 And then we, so we have sort of various different solutions. 163 00:12:52,934 --> 00:12:59,374 , but, um, ultimately, it becomes a financial choice because you are, you're like, yeah, this would work. 164 00:12:59,614 --> 00:13:02,014 But equally we're like, we don't wanna run out of money. 165 00:13:02,370 --> 00:13:11,440 Tim: And so just these chatbots, they're presumably, they are doing a lot of work. 166 00:13:11,820 --> 00:13:15,040 Are they, so is this sort of large, large language models? 167 00:13:15,050 --> 00:13:16,430 Are they, do they have personalities? 168 00:13:16,431 --> 00:13:17,030 Are they. 169 00:13:17,150 --> 00:13:25,710 Sort of trying to mimic being an individual with a condition who can't really describe exactly what's going on. 170 00:13:25,720 --> 00:13:29,590 They just know that they're having difficulty breathing or what have you. 171 00:13:30,280 --> 00:13:37,720 Caroline Morton: Yeah, so that's, um, so what's been really interesting for us is like how ChatGPT has sort of forced us to innovate in many ways. 172 00:13:37,770 --> 00:13:45,080 I had a prototype of the chat bot probably back in 2018, which was very much a command 173 00:13:45,080 --> 00:13:49,730 line tool in Python, you could ask a question and it would give you some response. 174 00:13:49,810 --> 00:13:54,900 Um, which wasn't very good and that was just using a Python library, open source library. 175 00:13:55,250 --> 00:14:01,890 We initially were using that, and, um, it was, it wasn't like brilliant, I would say. 176 00:14:02,280 --> 00:14:06,890 Uh, we tried sorts of different ways of making it better, but the main thing, people loved the chatbot. 177 00:14:07,270 --> 00:14:10,330 Um, and this is obviously before ChatGPT. 178 00:14:10,360 --> 00:14:16,750 We didn't really, we had no idea that was coming, gonna, But people were like, oh, this is amazing. 179 00:14:17,120 --> 00:14:22,120 Even if it wasn't very good and they were very tolerant of the fact it wasn't very good because they got to speak to this patient. 180 00:14:22,590 --> 00:14:28,490 Um, then we've moved to, yeah, we moved to sentence embedding. 181 00:14:28,520 --> 00:14:31,270 So basically, I was a bit unhappy with the Python chatbot. 182 00:14:31,880 --> 00:14:36,170 I took apart the open source library to find out how it worked. 183 00:14:36,640 --> 00:14:42,115 Um, and, And what was amazing to me was that it had ever worked at all, um, once I actually 184 00:14:42,115 --> 00:14:47,795 got into like the nitty gritty of how it was, how it actually did, um, like responded. 185 00:14:47,795 --> 00:14:52,235 So I rewrote it in Rust actually, that was one of the early things we did. 186 00:14:52,295 --> 00:14:56,035 I know it sounds a bit insane, but that was like one of my early Rust projects was rewriting it. 187 00:14:56,895 --> 00:14:59,545 Um, and then we eventually went to sentence embeddings. 188 00:15:01,385 --> 00:15:11,745 Tim: I have a very small, uh, point to make about, or at least people often ask the best way to learn Rust. 189 00:15:12,935 --> 00:15:22,525 And I usually say the best thing to do is to write something that you have a good understanding of the domain, like essentially rewrite something 190 00:15:22,525 --> 00:15:32,085 smallish, not trivial, but I think it's a really good approach because like it's very health, because you don't want to be learning a new thing. 191 00:15:32,405 --> 00:15:34,175 Like I need to write a chat bot. 192 00:15:35,945 --> 00:15:36,745 Like how do I do that? 193 00:15:37,350 --> 00:15:38,880 And learn Rust at the same time. 194 00:15:39,050 --> 00:15:43,320 Like we really, like you were talking about cognitive overload, kind of need 195 00:15:43,320 --> 00:15:49,160 to retain a little bit of working memory in order to continue to move forward. 196 00:15:49,910 --> 00:15:51,240 Caroline Morton: Yeah, I totally agree with that. 197 00:15:51,240 --> 00:15:59,920 I think it's so important, uh, to not, you want to get that sweet spot, where it's difficult enough that it challenges 198 00:15:59,920 --> 00:16:05,280 you and is interesting, but it's not so overwhelming that you just want to give up. 199 00:16:05,580 --> 00:16:11,435 I think, you know, the major advantage that, I had, um, well, I had two huge advantages. 200 00:16:11,435 --> 00:16:13,325 One, I had Max. 201 00:16:13,825 --> 00:16:20,665 And so, you know, if you've got a buddy, I'd highly recommend you always have a buddy who is better than you at whatever 202 00:16:20,665 --> 00:16:23,705 you're trying to learn, because you can just ask them, how would I do this? 203 00:16:23,705 --> 00:16:26,235 Or just watch them code something up. 204 00:16:26,235 --> 00:16:31,505 And you just get a lot of understanding about different design patterns and different approaches to how they break down a problem. 205 00:16:31,885 --> 00:16:32,825 That was the sort of. 206 00:16:33,330 --> 00:16:35,090 Huge advantage I had. 207 00:16:35,420 --> 00:16:42,130 The second advantage though was, which I do not recommend to other people, is we had customers. 208 00:16:42,690 --> 00:16:46,340 So it wasn't, you know, it wasn't like, oh, this is a toy project. 209 00:16:46,370 --> 00:16:47,710 I've, oh, it's got a bit hard. 210 00:16:47,740 --> 00:16:50,590 I'll just give up and maybe start again with a new repo. 211 00:16:51,070 --> 00:16:53,080 It was like, oh, we've got customers. 212 00:16:54,220 --> 00:16:54,800 So, 213 00:16:54,900 --> 00:16:56,440 Tim: And actually they've got needs. 214 00:16:57,100 --> 00:16:58,875 Caroline Morton: They've got needs and it's 2 a. 215 00:16:58,875 --> 00:16:59,205 m. 216 00:16:59,215 --> 00:17:01,205 Um, I've this has got to be written. 217 00:17:01,215 --> 00:17:08,945 So, um, that's just how it is and that really accelerated my learning curve, but it was I would say a slightly painful experience at the time 218 00:17:11,240 --> 00:17:16,710 Tim: As a doctor, do you have any tips for, uh, essentially long extended periods of work? 219 00:17:16,840 --> 00:17:23,920 Uh, this seems to be something that's drilled into everyone that junior doctors have to work. 220 00:17:25,725 --> 00:17:30,815 Lots of hours and do lots and lots, essentially many, many rounds. 221 00:17:30,815 --> 00:17:34,505 I don't know what the metric is, like what the unit of time, I suppose it shifts. 222 00:17:34,865 --> 00:17:42,465 Um, but it does seem to me that, I don't know if there is any way that there's 223 00:17:42,465 --> 00:17:47,565 this kind of problem of like grinding people, like grinding the soul out of them. 224 00:17:47,785 --> 00:17:47,935 You 225 00:17:48,045 --> 00:17:57,810 Caroline Morton: Yeah, I think I do agree I saw I can see it from both sides and I think you know, when I was like in F1, which 226 00:17:57,820 --> 00:18:06,110 is like the first year you're a doctor, uh, Foundation Year One, um, it was just a miserable experience to be totally honest with you. 227 00:18:06,390 --> 00:18:07,060 Um, 228 00:18:07,915 --> 00:18:08,185 Tim: Yeah, 229 00:18:08,315 --> 00:18:11,335 Caroline Morton: You do is sleep and work pretty much. 230 00:18:11,395 --> 00:18:24,745 Um, but then, you know, you, you also need a system which can output, you know, you know, it's a production line that people forget this. 231 00:18:24,745 --> 00:18:32,665 Like you want output thousands of doctors who are qualified in being GPs or being cardiologists or surgeons. 232 00:18:33,045 --> 00:18:36,695 And that production time needs to be as short as possible. 233 00:18:36,900 --> 00:18:43,020 for it to be effective and essentially you can't, you know, if it takes seven years, or say it would 234 00:18:43,020 --> 00:18:50,645 take five years to be a GP, um, you know, unless you want that to be 10 years, you have to really, 235 00:18:51,170 --> 00:18:52,110 Tim: Do the hours, right? 236 00:18:52,355 --> 00:18:53,175 Caroline Morton: Have to do the hours. 237 00:18:53,175 --> 00:19:01,415 There is a volume thing, again, where you just need to see, like, I've seen thousands of patients and that's just, you know, 238 00:19:01,460 --> 00:19:01,750 Tim: Yeah. 239 00:19:01,750 --> 00:19:07,470 I, so there's a couple of things I should pause there just because there'll be some people that don't understand the terminology. 240 00:19:07,660 --> 00:19:13,340 So in the British system, which I've, I guess I've inherited the big GP stands for general practitioner. 241 00:19:13,420 --> 00:19:15,500 So this is essentially a family doctor would, I 242 00:19:15,525 --> 00:19:16,025 Caroline Morton: that's what I 243 00:19:16,080 --> 00:19:16,560 Tim: be a term. 244 00:19:17,900 --> 00:19:21,580 Um, that's quite a difficult specialty. 245 00:19:22,185 --> 00:19:24,415 As I understand it, is that correct? 246 00:19:25,015 --> 00:19:25,255 Caroline Morton: Yeah, 247 00:19:25,385 --> 00:19:26,555 Tim: I don't know if there's any such as a 248 00:19:27,255 --> 00:19:27,565 Caroline Morton: yeah, 249 00:19:28,935 --> 00:19:29,475 Tim: Because I, 250 00:19:29,789 --> 00:19:32,265 Caroline Morton: think so, it's one of those, 251 00:19:32,265 --> 00:19:32,475 Tim: mean, 252 00:19:34,635 --> 00:19:42,970 I was going to say, I guess It's all hard, but I think if you're dealing with people and we call them primary health organization. 253 00:19:42,980 --> 00:19:52,950 So if like, if you're in a practice talking to patients who, you know, everything is different, there's no continuity. 254 00:19:53,310 --> 00:19:58,690 You, some of them you have just met for the first time, others you have dealt with for the last 255 00:19:58,700 --> 00:20:07,160 several years and they trust you and you've got to do all of that within a 15 minute consultation. 256 00:20:07,570 --> 00:20:10,060 Um, strikes me as particularly challenging. 257 00:20:10,330 --> 00:20:19,470 , Caroline Morton: It's one of those things where it's really, if you ask lots of doctors who are not, who are not GPs, um, this is kind of, I 258 00:20:19,480 --> 00:20:23,510 mean, hopefully it's got a bit better now, but it used to be like, oh, they're just a GP, it's 259 00:20:23,510 --> 00:20:27,730 like, you're not smart enough to do, you know, one of the proper professions, like anaesthetics 260 00:20:27,875 --> 00:20:29,915 Tim: yeah, yeah, you're not in a hospital, right? 261 00:20:29,915 --> 00:20:32,945 You're a community, community practice, right? 262 00:20:32,946 --> 00:20:35,405 It's like, it's like a serious, serious medicine. 263 00:20:35,845 --> 00:20:36,245 Um, 264 00:20:36,805 --> 00:20:37,735 Caroline Morton: but it's 265 00:20:37,855 --> 00:20:38,435 Tim: could even be worse. 266 00:20:38,505 --> 00:20:39,455 It could be dentistry. 267 00:20:40,375 --> 00:20:40,735 Caroline Morton: Yeah. 268 00:20:40,825 --> 00:20:42,715 Although, you know, you'd be rolling in the cache. 269 00:20:42,715 --> 00:20:43,735 So, um, 270 00:20:45,485 --> 00:20:45,825 Tim: That's true. 271 00:20:45,945 --> 00:20:46,275 Caroline Morton: praise and 272 00:20:46,325 --> 00:20:46,955 Tim: I don't know, but 273 00:20:49,135 --> 00:20:57,055 the distinction between, uh, medicine and dentistry is the weirdest thing, by the way, I just find that the most bizarre historical quirk. 274 00:20:57,875 --> 00:21:04,675 , Caroline Morton: We shared a medical school with, or we shared a physical building with the dental school, uh, and. 275 00:21:05,610 --> 00:21:14,350 You, I think I met, I was there six years, I met one dentist, like it, they sort of, you, you just never saw them and they presumably never saw us. 276 00:21:14,350 --> 00:21:20,230 It was just a very strange sort of, like, I know they're here somewhere, but who knows where. 277 00:21:20,300 --> 00:21:21,630 Um, so 278 00:21:21,865 --> 00:21:32,095 Tim: Yeah, well, um, the other term that I wanted to just to clarify was junior doctor, because it sounds like something, it's like, oh, you must 279 00:21:32,095 --> 00:21:39,205 be 19, but no, no, no, no, no, the term junior doctor is reserved for someone who's gone all the way through medical school, gone then through 280 00:21:40,025 --> 00:21:48,085 specialist training and is then going through the process of essentially becoming the next step after that, I think is consultant, correct? 281 00:21:48,105 --> 00:21:50,305 Or like senior doctor, then consultant or 282 00:21:50,860 --> 00:21:51,150 Caroline Morton: no. 283 00:21:51,150 --> 00:21:51,520 So you're 284 00:21:51,595 --> 00:21:51,935 Tim: so, but 285 00:21:52,450 --> 00:22:00,930 Caroline Morton: you're a junior doctor from the day you graduate medical school until you become either a fully qualified GP. 286 00:22:01,225 --> 00:22:04,875 or a fully qualified consultant, which is a bit of an 287 00:22:05,055 --> 00:22:06,155 Tim: that would be the difference in the hospital. 288 00:22:06,275 --> 00:22:06,735 Caroline Morton: Yeah. 289 00:22:06,775 --> 00:22:07,305 Yeah. 290 00:22:07,545 --> 00:22:07,835 So, 291 00:22:08,145 --> 00:22:09,525 Tim: Um, yeah. 292 00:22:09,635 --> 00:22:09,965 Okay. 293 00:22:09,975 --> 00:22:12,885 So we've got, we've gone through many arcane details of like, 294 00:22:15,115 --> 00:22:25,165 so this is actually one of the things I think I think that I was mostly curious about when I, um, when I was thinking about this 295 00:22:25,175 --> 00:22:33,515 interview, which is that you've devoted a huge amount of your life to the profession. 296 00:22:35,910 --> 00:22:52,190 And, if this thing that you're building works, then it could maybe change Outcomes for patients worldwide, let's say, just, just, 297 00:22:52,200 --> 00:22:58,580 just steer the needle ever so slightly towards like, you know, whereas as an individual, 298 00:22:59,410 --> 00:23:05,265 you're sort of limited to those Just this quote, small number of thousands of patients. 299 00:23:05,555 --> 00:23:11,535 Um, I don't know if that was, uh, was, was, was that the kind of calculus that you were going through? 300 00:23:12,235 --> 00:23:12,865 Caroline Morton: Yeah. 301 00:23:13,165 --> 00:23:16,575 So I would say so it's definitely played into it. 302 00:23:16,635 --> 00:23:24,685 The simulation program came from something that's just used to, basically just used to annoy me so much whenever I did simulation training, because 303 00:23:24,705 --> 00:23:33,125 you would typically go into a room and there would be a simulator and you would say, you know, the, the simulator would say, or the simulator 304 00:23:33,125 --> 00:23:37,515 patient would say, I've got chest pain, and then you would say, Oh, I'd order this, an ECG 305 00:23:37,516 --> 00:23:43,380 and a troponin, which is a blood test, and then you would be handed those results immediately. 306 00:23:43,550 --> 00:23:45,430 It's like, this is not realistic. 307 00:23:45,630 --> 00:23:50,920 In real, like, in real life, my bleep would be going off, which is like the little pager, which we still use. 308 00:23:51,280 --> 00:24:00,200 And, um, all of, you know, and, but you'd also have like 30 patients and you'd have, you know, ward rounds to compare, like, and handover. 309 00:24:00,620 --> 00:24:06,590 And so, really, it very much started as a pet project of mine because I was like, this is so annoying. 310 00:24:06,590 --> 00:24:08,790 It's like, I've got to solve this problem. 311 00:24:09,680 --> 00:24:15,050 Um, and then, you know, it's slightly gotten a bit out of hand and now it's my full time job. 312 00:24:15,360 --> 00:24:27,090 Um, but yeah, the idea is to try and get, um, People to take this training and then they can also have some way of standardizing the 313 00:24:27,090 --> 00:24:31,380 sort of, like, it's not trying to replace like going into hospitals, talking to patients. 314 00:24:31,380 --> 00:24:35,200 That's obviously a key part of training, like still training. 315 00:24:35,200 --> 00:24:37,860 It should still be an apprenticeship model in that way. 316 00:24:38,480 --> 00:24:49,695 But, um, you know, you can't guarantee when you're doing your, uh, I don't know, neurology block that you're definitely like in that two week period, 317 00:24:49,695 --> 00:24:59,185 you're definitely going to see somebody who's got status or which is an epileptic, you know, you know, unresponsive basically to typical things. 318 00:24:59,205 --> 00:25:04,860 Anyway, um, the point is, um, you can't guarantee that you're going to see a 319 00:25:04,860 --> 00:25:10,670 patient with that condition in your two weeks that you'll happen to be there. 320 00:25:11,280 --> 00:25:16,420 Especially the serious ones, because they should be stopped or, you know, like stroke, um, patients 321 00:25:16,450 --> 00:25:20,970 get taken straight into the cath lab now, or they get straight into like, and have the clot removed. 322 00:25:21,170 --> 00:25:25,730 That might completely remove the medical student from, from even seeing that. 323 00:25:26,080 --> 00:25:27,470 And so, um, 324 00:25:27,540 --> 00:25:27,780 Tim: right. 325 00:25:27,830 --> 00:25:29,670 The, so the, so, so what you're 326 00:25:29,925 --> 00:25:31,265 Caroline Morton: It's like trying to standardize it. 327 00:25:31,335 --> 00:25:31,745 Yeah. 328 00:25:32,850 --> 00:25:36,950 Tim: is through some sort of the, the apprenticeship model. 329 00:25:36,970 --> 00:25:42,190 Ideally, we would like to expose students to as many patients as possible. 330 00:25:42,370 --> 00:25:44,410 However, there are some of them who are so severe. 331 00:25:44,410 --> 00:25:48,040 So a very, very sick that they really need help right now. 332 00:25:48,525 --> 00:25:58,255 Which actually means that they basically get, they bypass, these, these critical cases essentially can't be trained on, which is- 333 00:25:58,325 --> 00:25:59,775 Caroline Morton: Yeah, they bypass. 334 00:25:59,825 --> 00:26:05,085 And also you might, they just, random chance, you know, they just might not, you know, have turned up. 335 00:26:05,095 --> 00:26:08,995 I did a week of ENT in my whole medical, like medical school training. 336 00:26:09,405 --> 00:26:15,245 I obviously didn't see the vast majority of ENT conditions, uh, during that time. 337 00:26:15,695 --> 00:26:18,495 Um, and you could say that about lots of specialties. 338 00:26:18,505 --> 00:26:25,575 So I think, you know, you want to be able to standardize the sort of, you know, learning opportunities that people 339 00:26:25,575 --> 00:26:31,465 have had and this is part of what we're trying to do, if that makes sense. 340 00:26:32,575 --> 00:26:33,405 Tim: I think so. 341 00:26:33,435 --> 00:26:42,210 I think that there is a difficulty with kind of edutech in the sense of it can be. 342 00:26:42,211 --> 00:26:52,770 Because it's so good at being instrumented, it can kind of be weaponized against you in a little bit, at least. 343 00:26:53,250 --> 00:26:55,405 There's two sides of the coin. 344 00:26:55,775 --> 00:27:01,885 If I wanted to learn, if I wanted to do extra work, I'd go on to Khan Academy, for example, and 345 00:27:01,885 --> 00:27:07,645 I would like learn mathematics and I would kind of push myself ahead, or I could go via classroom. 346 00:27:08,135 --> 00:27:16,215 All of these EduTech platforms essentially provide very specific metrics about individual performance to educators. 347 00:27:17,525 --> 00:27:33,685 And I sort of have this personal wince about the idea that you're actually exposing people to, uh, I don't know, humiliation, although I 348 00:27:33,685 --> 00:27:43,860 guess in the space of like medicine, learn very quickly, presumably that everything is observable. 349 00:27:43,920 --> 00:27:51,790 Essentially, like all of your decisions are, that's why you're copiously writing notes because there are reviews and essentially 350 00:27:51,790 --> 00:28:02,270 everything that you decide to do, uh, you know, every diagnostic tool that you asked for, or, you know, did you ask for too many? 351 00:28:02,750 --> 00:28:06,990 Were you, uh, all of your clinical interventions, when were they discharged? 352 00:28:06,990 --> 00:28:08,980 All of those decisions get checked. 353 00:28:09,830 --> 00:28:11,610 And maybe, so maybe it's not appropriate. 354 00:28:11,650 --> 00:28:11,970 I don't know. 355 00:28:11,970 --> 00:28:15,030 I just have this kind of personal, uh, 356 00:28:15,105 --> 00:28:15,525 Caroline Morton: point. 357 00:28:15,555 --> 00:28:23,125 I, uh, so, I mean, one, I, something I thought a lot about, um, especially because you don't want to discourage people from, 358 00:28:23,575 --> 00:28:31,205 um, you know, you don't want to create an environment in which the the, say, if we, you know, quote unquote, the poor performers 359 00:28:31,465 --> 00:28:36,475 are, you know, worried about being punished in some way, so they stop engaging with it. 360 00:28:36,505 --> 00:28:40,145 So the separation between the top performers and the poor performers just increases. 361 00:28:40,665 --> 00:28:42,385 Uh, that's definitely not what we want. 362 00:28:42,405 --> 00:28:51,245 So it's something we thought a lot about the other, um, You know, we work very closely with the universities in Germany, 363 00:28:51,305 --> 00:28:55,285 and Germany actually has some quite interesting sort of data protection laws. 364 00:28:55,295 --> 00:29:01,385 So one of the caveats was you couldn't pick up individual people and say, you 365 00:29:01,385 --> 00:29:07,415 know, um, you know, Sharon is doing really, yeah, is doing really badly at this. 366 00:29:07,445 --> 00:29:17,440 And so what the teachers get is a broad summary view of how their students are performing per disease. 367 00:29:17,870 --> 00:29:27,430 And so, um, one of the things, so for example, we, I'm going to talk about cardiology because that's just recently what we just did, so the, 368 00:29:27,720 --> 00:29:34,255 like, You might have a cardiology block, and you know, it's very tempting when you're a teacher, or even you're a junior doctor, junior doctors 369 00:29:34,255 --> 00:29:40,355 do a lot of the teaching of medical students, like, okay, cardiology, the most important thing to think about is, like, myocardial infarction, 370 00:29:40,355 --> 00:29:44,325 which is like, you know, you've got a blockage in your heart, you get a sort of heart attack. 371 00:29:44,665 --> 00:29:46,860 Um, And, 372 00:29:47,040 --> 00:29:51,920 Tim: feel like just pausing there and just saying that myocardial infarction is because so the 373 00:29:52,710 --> 00:29:59,260 myocardium is a part of a part of the heart, which, um, and infarction is, yeah, like a, yeah. 374 00:29:59,870 --> 00:30:01,720 Is it Greek or Latin for stoppage? 375 00:30:01,720 --> 00:30:02,280 I'm not sure. 376 00:30:03,050 --> 00:30:03,750 Caroline Morton: oh, I don't know. 377 00:30:05,120 --> 00:30:06,180 It's bad. 378 00:30:06,210 --> 00:30:07,740 You haven't got enough blood supply going 379 00:30:07,810 --> 00:30:08,500 Tim: Yeah, that's right. 380 00:30:08,500 --> 00:30:08,700 Yeah. 381 00:30:08,700 --> 00:30:11,670 Essentially like life is getting, um, very short for you. 382 00:30:12,380 --> 00:30:13,260 Caroline Morton: and it's painful. 383 00:30:13,300 --> 00:30:18,740 Um, and so that's, you know, one of the big kind of ticket items in terms of cardiology. 384 00:30:18,750 --> 00:30:22,735 You always want to make sure that you are, you know, capturing that and, you're not 385 00:30:22,735 --> 00:30:27,345 missing any, but it's also so typical that the medical students know it really well. 386 00:30:27,375 --> 00:30:28,365 They know chest pain. 387 00:30:28,365 --> 00:30:30,885 They know it's, that's the thing you need to look out for. 388 00:30:30,935 --> 00:30:38,895 And what they're less good at is dealing with, um, and I think genuinely they do receive less teaching on is things like heart 389 00:30:38,895 --> 00:30:42,585 failure, which, you know, kills hundreds of people, thousands of people a year. 390 00:30:42,985 --> 00:30:48,335 Um, some of the arrhythmias, which are perhaps less common, but maybe do present. 391 00:30:48,920 --> 00:30:52,010 in the emergency rooms in slightly atypical ways. 392 00:30:52,520 --> 00:30:53,080 And so 393 00:30:53,580 --> 00:30:56,490 Tim: Oh, so there's another point that we should possibly raise for a generalist 394 00:30:56,490 --> 00:31:06,190 audience is that the, this flatlining kind of cardiogram is, is not what happens in real life. 395 00:31:06,190 --> 00:31:13,140 If someone's, if someone's heart is distressed, the, the rhythm that the cardiogram has will look very odd. 396 00:31:13,540 --> 00:31:17,260 Um, and there are different patterns which require different interventions. 397 00:31:18,920 --> 00:31:20,290 Caroline Morton: Thank you, that's useful. 398 00:31:21,230 --> 00:31:31,540 Um, I, so I, what teachers can do is that they can then look at, say, I've included six diseases in this class. 399 00:31:32,230 --> 00:31:38,050 Um, and even though all of the students have played, they play the role of the doctor and they've seen different 400 00:31:38,050 --> 00:31:41,610 patients with these different conditions because they're all unique patients. 401 00:31:42,030 --> 00:31:50,190 They can say, oh, broadly speaking, my patient, my students are not good at, um, you know, treating heart failure. 402 00:31:50,700 --> 00:31:54,300 And so I'm going to give some specific teaching about heart failure because 403 00:31:54,310 --> 00:31:58,000 that's an area that they don't know as well, or they're not picking up as well. 404 00:31:58,040 --> 00:32:05,548 And we often see when we look at these, maybe you have six diseases within a certain class, we often see that they're doing really well with myocardial 405 00:32:05,548 --> 00:32:11,078 infarction that we talked about, um, but they're doing very poorly with things like heart failure. 406 00:32:11,268 --> 00:32:16,838 Or, alternatively, they get the diagnosis right, um, of the, you know, 407 00:32:17,523 --> 00:32:20,663 terrible chest pain that you're having, but they don't give any pain relief. 408 00:32:20,913 --> 00:32:22,543 That's a very common thing that we see. 409 00:32:22,813 --> 00:32:24,183 And that's very true to life. 410 00:32:24,213 --> 00:32:31,773 You do see that in, you know, you get people in the emergency room who, you know, they get the right diagnosis, but they don't 411 00:32:32,053 --> 00:32:37,953 then end up having any pain relief, which is the thing that they care about, is, you know, to get rid of this terrible pain. 412 00:32:38,363 --> 00:32:42,183 Um, and so we are picking up those things. 413 00:32:42,253 --> 00:32:44,088 Uh, we are picking up those things and. 414 00:32:44,088 --> 00:32:52,128 The fact that it does reflect like what I've seen in real life and what other people have seen is, is reassuring. 415 00:32:52,438 --> 00:32:59,738 Um, so yeah, so, but back to the question, which was, you know, are we picking out individual students? 416 00:32:59,738 --> 00:33:08,258 We're not, uh, they can see their own performance, but teachers can't see anything other than the sort of metric at a class level. 417 00:33:10,413 --> 00:33:14,143 Tim: Ostensibly, this is a Rust discussion, but this is fascinating to me. 418 00:33:14,143 --> 00:33:18,633 So I have one other thing about planning this. 419 00:33:18,813 --> 00:33:28,513 Do you ever have a very, like, I don't know what the, uh, I always try, I always get stuck on the pronunciation of this word. 420 00:33:28,563 --> 00:33:31,813 Is it pedagogy, pedagogy? 421 00:33:32,163 --> 00:33:37,953 Caroline Morton: Oh yeah, yeah, it's not, we don't really use it as commonly in the UK to be honest, but other people use it. 422 00:33:38,173 --> 00:33:40,273 Tim: Okay, um, right. 423 00:33:40,273 --> 00:33:47,213 So if from like an instructional design point of view, if you were to just 424 00:33:47,243 --> 00:33:53,793 give a boring day in the simulation, like, is that something that's of like. 425 00:33:54,353 --> 00:33:54,963 Worth? 426 00:33:55,063 --> 00:34:01,063 Do you ever just kind of not have really tricky, odd kind of test cases in there? 427 00:34:01,313 --> 00:34:03,623 Or is that kind of silly? 428 00:34:04,273 --> 00:34:05,793 Caroline Morton: No, I think it's a really good idea. 429 00:34:05,803 --> 00:34:12,983 I think, so we don't necessarily have boring patients in the sense they all do have something wrong with them. 430 00:34:13,473 --> 00:34:15,183 Um, I have 431 00:34:15,253 --> 00:34:21,563 Tim: You don't have someone coming in and asking, essentially that, actually paracetamol or what have you is fine. 432 00:34:21,838 --> 00:34:22,308 Go home. 433 00:34:23,113 --> 00:34:24,733 Caroline Morton: we do have a couple of patients. 434 00:34:25,913 --> 00:34:27,943 like, um, scenarios or you're not patient. 435 00:34:27,943 --> 00:34:38,463 So diseases where, um, essentially the treatment is like go home and rest and take ibuprofen, um, things like musculoskeletal pain. 436 00:34:38,923 --> 00:34:43,043 Um, and we do have like a, you know, cold. 437 00:34:45,088 --> 00:34:45,938 Um, 438 00:34:46,118 --> 00:34:47,938 Tim: do turn up to the ED with cold. 439 00:34:48,358 --> 00:34:53,328 Caroline Morton: Oh yeah, I mean, I used to, I mean, I, when I was working in general practices, 440 00:34:53,328 --> 00:35:00,168 I used to get a cold literally every two weeks because I saw so many sick kids for, for winter. 441 00:35:01,038 --> 00:35:05,648 Um, so yeah, it was, yes, I, I don't miss that aspect of it. 442 00:35:06,238 --> 00:35:08,903 Um, But yeah, we do have them. 443 00:35:08,913 --> 00:35:14,103 We don't do purposely boring, uh, shifts, but 444 00:35:14,418 --> 00:35:16,888 Tim: No, no, no, it was just, I, more, more out of curiosity. 445 00:35:16,888 --> 00:35:17,148 I don't 446 00:35:17,413 --> 00:35:25,503 Caroline Morton: I think it's a good point, and we do have, um, we, I would say the vast majority of the, the diseases, they do present 447 00:35:25,523 --> 00:35:34,278 in the sort of classic boring way, you know, the chest pain patient, uh, and then there's sprinkled in, there are a few, you know, um, 448 00:35:34,918 --> 00:35:42,328 You know, and more unusual presentations of the same condition and so there is you have to make sure that you're still looking out for those 449 00:35:43,748 --> 00:35:49,058 Those you whatever it is that's presenting as something slightly unusual, which which happens 450 00:35:49,678 --> 00:35:56,918 Tim: Do patients ever get transferred to the doctor in a way that either misses or misrepresents? 451 00:35:58,398 --> 00:35:59,968 So it's essentially the handover. 452 00:35:59,988 --> 00:36:04,208 Um, and they have to go through the process. 453 00:36:05,138 --> 00:36:10,778 Caroline Morton: we don't have that but we are just gonna have handover happening. 454 00:36:11,218 --> 00:36:17,548 Uh, from, you can arrive in the emergency room via the ambulance or via just walk in. 455 00:36:17,948 --> 00:36:23,148 And so there's, um, in the new version, hopefully which will be out in Autumn 456 00:36:23,148 --> 00:36:29,268 time, there will be a, uh, capacity to have like a triage nurse give a hand over. 457 00:36:29,928 --> 00:36:36,418 And an ambulance, crew give a handover and I think I might add some variation into that. 458 00:36:36,418 --> 00:36:40,378 So sometimes they're just missing, um, you know, maybe not from the ambulance 459 00:36:40,378 --> 00:36:43,568 crew, but certainly from, you know, maybe the, the nurse hasn't got to them yet. 460 00:36:44,008 --> 00:36:46,778 Um, and so there is no sort of handover. 461 00:36:47,228 --> 00:36:48,348 Um, so yeah, there's, there's 462 00:36:48,448 --> 00:36:48,708 Tim: Right. 463 00:36:48,748 --> 00:36:50,628 So you arrive before the handover does. 464 00:36:50,638 --> 00:36:53,728 And so the patient's waiting there to be, and you, okay. 465 00:36:53,728 --> 00:36:55,278 Yeah. 466 00:36:55,348 --> 00:37:00,058 Caroline Morton: to decide from the, it's sort of the, you've got to decide who you take first. 467 00:37:00,178 --> 00:37:01,788 So everyone starts in the waiting room. 468 00:37:02,548 --> 00:37:09,928 So you've got to make your decisions about who you take first, and that can also cause problems, because you might be very tempted 469 00:37:09,928 --> 00:37:17,488 to take the older person, who seems like, you know, they're really sick, because they're, I don't know, they've got chest pain, it 470 00:37:17,488 --> 00:37:21,328 turns out they've just pulled a muscle, wear it, and you've missed the 44 year old. 471 00:37:22,038 --> 00:37:25,278 who's got, who's actually having a serious medical complaint. 472 00:37:25,688 --> 00:37:26,068 Yeah. 473 00:37:26,068 --> 00:37:31,918 So, um, there are, yeah, there's sort of, you make decisions about, you know, who you should take 474 00:37:32,918 --> 00:37:33,958 Tim: I am laughing to myself. 475 00:37:34,443 --> 00:37:38,593 Yeah, no, I was going to say, well, do you have staff walkouts and how much of other kind of complaints? 476 00:37:38,913 --> 00:37:41,693 Like what if someone forgets to put the T on? 477 00:37:42,093 --> 00:37:42,643 Um, 478 00:37:42,888 --> 00:37:43,328 Caroline Morton: yeah. 479 00:37:43,328 --> 00:37:50,638 I mean, the only sort of distraction we have at the moment is the bleep, which is the bane of my life when I was a junior doctor. 480 00:37:51,418 --> 00:38:00,488 Um, I mean, I, it was, I had such a, I think it's a response to it that any time I heard a beep noise 481 00:38:00,683 --> 00:38:02,133 Tim: beep, beep, beep, beep. 482 00:38:02,258 --> 00:38:07,838 Caroline Morton: years, I used to look down at my right hip where my pager was or wasn't and, um, 483 00:38:07,878 --> 00:38:12,578 and look for the bleep, even though I was on the tube or somewhere, it was just someone's phone. 484 00:38:12,608 --> 00:38:15,538 Um, so yeah, that was a big distraction. 485 00:38:15,858 --> 00:38:19,868 Um, but yeah, we, we have capacity to add in more distractions. 486 00:38:20,223 --> 00:38:28,453 Tim: Yeah, I'm sure they're just like, uh, it will be hard to try to make sure to kind of stop building new stuff. 487 00:38:28,483 --> 00:38:30,793 Cause you could always add more complexity. 488 00:38:31,243 --> 00:38:32,823 Um, and 489 00:38:33,038 --> 00:38:39,178 Caroline Morton: learning point for me is it's very tempting to add more and more features, but feature creep really is a. 490 00:38:39,578 --> 00:38:40,818 Is a really big problem. 491 00:38:40,838 --> 00:38:50,088 And so, um, it's really important to just make sure that you are just making sure that the things first are things which people 492 00:38:50,128 --> 00:38:56,468 actually want and, uh, that you have been paid to do or someone is willing to pay for. 493 00:38:56,768 --> 00:38:58,098 Um, and. 494 00:38:59,023 --> 00:39:06,033 Yeah, so that's, that's a, it's definitely a learning experience running a company and having to start thinking about these things. 495 00:39:07,063 --> 00:39:17,393 Tim: So, how do you describe yourself to, let's say a friend of a friend you, uh, like how, how do you introduce yourself? 496 00:39:18,523 --> 00:39:21,193 Caroline Morton: Oh, that is a, that's a difficult question. 497 00:39:22,643 --> 00:39:24,453 Tim: I know it's, it's awful. 498 00:39:25,253 --> 00:39:25,633 Sorry. 499 00:39:25,643 --> 00:39:27,313 It is, it is a challenging one. 500 00:39:27,483 --> 00:39:32,523 Caroline Morton: so I've, I've adopted the, I've adopted the handle of like, uh, I'm just going 501 00:39:32,523 --> 00:39:37,553 to call myself a software engineer now, which feels kind of still slightly uncomfortable. 502 00:39:37,883 --> 00:39:40,513 Um, but I think. 503 00:39:40,953 --> 00:39:44,773 You know, I've been writing, I've been writing software for like three and a half 504 00:39:44,773 --> 00:39:50,623 years full time and You know because I wasn't even before I went to the company full time. 505 00:39:50,623 --> 00:39:58,813 I was writing software and not working as a doctor and so it's yeah, that's that's 506 00:39:58,813 --> 00:40:03,833 what I've decided to go for and that might annoy people but that's what I'm going for 507 00:40:05,033 --> 00:40:06,113 Tim: Who would it annoy? 508 00:40:08,063 --> 00:40:10,773 Caroline Morton: Yeah, I think It's difficult. 509 00:40:10,823 --> 00:40:11,063 Tim: Sure. 510 00:40:11,423 --> 00:40:14,903 So, so, uh, may I, oh, let's, let's ask that again. 511 00:40:15,133 --> 00:40:17,493 So if I could probe slightly. 512 00:40:17,563 --> 00:40:26,973 I'm curious as to, are you saying that you haven't earned your place to call yourself a software developer? 513 00:40:27,023 --> 00:40:28,143 Is that what you're saying? 514 00:40:28,593 --> 00:40:37,023 Caroline Morton: I sometimes feel that, um, because I haven't done sort of the equivalent of junior doctor, doctoring in software. 515 00:40:37,573 --> 00:40:43,363 , Tim: it helps, I don't know if this does, people fly me around the world to listen to me speak. 516 00:40:44,643 --> 00:40:44,793 Caroline Morton: that 517 00:40:44,903 --> 00:40:45,293 Tim: I have 518 00:40:45,553 --> 00:40:46,723 Caroline Morton: great gig if I can get it. 519 00:40:46,723 --> 00:40:48,443 So that 520 00:40:49,203 --> 00:40:53,163 Tim: I will look, if I can figure out a way to afford to bring you back to. 521 00:40:54,213 --> 00:41:05,203 a country with very, uh, if I can afford to bring you to, to, to New Zealand next August, I'll try the, um, but I also have not. 522 00:41:06,013 --> 00:41:11,303 So one of the things that software engineering, or even the term software engineering is difficult, right? 523 00:41:11,593 --> 00:41:16,893 That the software industry does not have centuries of practice. 524 00:41:16,893 --> 00:41:18,113 It doesn't know what it is. 525 00:41:18,973 --> 00:41:22,623 It means to be in the profession. 526 00:41:22,673 --> 00:41:23,933 It isn't a profession. 527 00:41:24,113 --> 00:41:25,023 Is it a vocation? 528 00:41:25,023 --> 00:41:26,243 It's really hard to know. 529 00:41:26,773 --> 00:41:36,833 It's primarily filled with people who are, most people describe themselves as self taught. 530 00:41:37,193 --> 00:41:42,103 There are very few people that start at university and go through a tradition, let's say a conventional education. 531 00:41:42,768 --> 00:41:44,058 Or educational pathway. 532 00:41:44,818 --> 00:41:50,268 There's a lot of frustration that people need to bulldoze through, I think, when you're learning to code. 533 00:41:50,488 --> 00:41:58,123 You're continuously fighting syntax and then semantics and you're always trying to use it. 534 00:42:00,213 --> 00:42:03,253 slightly away from what you want. 535 00:42:03,253 --> 00:42:09,043 You've got this conceptual idea about what you want to construct, want to build, but you're actually, you don't have the 536 00:42:09,073 --> 00:42:12,923 cognitive, you don't have the intellectual ability to actually implement it. 537 00:42:12,983 --> 00:42:14,823 And that's extremely frustrating. 538 00:42:15,903 --> 00:42:16,383 So if it's, 539 00:42:16,828 --> 00:42:24,238 Caroline Morton: even when it works though, and you've implemented the thing, I often find myself thinking, you know, Is this the right way? 540 00:42:24,628 --> 00:42:27,378 Like, have I, should I have used a different design pattern? 541 00:42:27,378 --> 00:42:32,688 So I'm a bit obsessive about reading like software engineering books, like trying to upskill in that area. 542 00:42:32,688 --> 00:42:41,438 I'm now going, I mean, ChatGPT is actually a great resource for, you know, asking questions like, what, what is this thing? 543 00:42:41,518 --> 00:42:42,398 Um, you 544 00:42:42,473 --> 00:42:43,533 Tim: yeah, no, I agree. 545 00:42:43,803 --> 00:42:45,063 I actually, 546 00:42:45,298 --> 00:42:45,618 Caroline Morton: Yeah. 547 00:42:46,983 --> 00:42:56,278 Tim: I think it's very nice from the, Although I've kind of defected slightly to Claude, um, which is, and the other one, um, 548 00:42:56,278 --> 00:43:02,088 although there are several other ones, but yeah, I, I think that these AI assistants 549 00:43:02,088 --> 00:43:08,248 are quite nice for being able to give you like a condensed Wikipedia page of a topic. 550 00:43:08,648 --> 00:43:17,328 Um, and I ask it silly questions, like, um, and I think that one of the nice things about software. 551 00:43:17,728 --> 00:43:21,538 Oh, so, so actually, no, I don't want to, I want to. 552 00:43:22,333 --> 00:43:37,838 Try to figure out If there's anything more that software can do, do better at allowing people who are changing careers to feel welcome? 553 00:43:38,098 --> 00:43:39,428 Um, is that. 554 00:43:39,768 --> 00:43:44,858 Caroline Morton: So I actually think the software engineer, the software engineering community does this very well. 555 00:43:45,268 --> 00:43:51,968 Um, because, and, you know, the fact there's so many, you know, all you need is a computer and an Internet connection and, you know, a 556 00:43:51,968 --> 00:43:56,088 bit of willpower and you can probably teach yourself, you know, and that's what we did. 557 00:43:56,088 --> 00:44:05,253 Like we've all pretty much, well, not all of us, obviously, uh, but, you know, Most of us have self taught, used books, used videos, whatever it is. 558 00:44:05,553 --> 00:44:11,403 Um, and so you can get into, I think you can get into this profession. 559 00:44:12,443 --> 00:44:16,233 And I wouldn't say, I don't, I mean, there's obviously some parts of the community which are 560 00:44:16,233 --> 00:44:24,623 a bit unfriendly, but, um, I think it's also, you know, we also have to look within ourselves. 561 00:44:24,803 --> 00:44:27,863 You know, I, no one said to me, oh, you're not a proper software engineer. 562 00:44:29,003 --> 00:44:31,143 I'm, I feel that sometimes. 563 00:44:31,183 --> 00:44:35,453 And so, and I think if you speak to lots of people, that's what they often will say. 564 00:44:35,913 --> 00:44:41,138 Um, And, you know, especially junior people, they might say, Oh, you know, I've just write a 565 00:44:41,138 --> 00:44:48,328 few lines of, of code, you know, or they'll have some way of couching it without using that label. 566 00:44:48,838 --> 00:44:52,678 Uh, so I decided three years ago, I was about, I was just going to start using it. 567 00:44:52,778 --> 00:44:56,638 And it felt really uncomfortable to start with, but now nobody's sort of really questions it. 568 00:44:57,198 --> 00:45:02,903 Uh, but it is, Yeah, it's something to have a think about, but it, you know, it's your own, it can be your own insecurities. 569 00:45:02,903 --> 00:45:05,893 It's not necessarily a problem, I would say, with the community, because actually I think the 570 00:45:05,893 --> 00:45:12,033 community is way more accepting of you being self taught than, I can't think of another profession. 571 00:45:12,648 --> 00:45:17,148 where they'd be like, you know, they're not exactly going to be like, I'm a self, I'm self taught civil engineer. 572 00:45:17,408 --> 00:45:24,438 They'd be like, you're not building a bridge, like get out of here, like, or I'm a self taught doctor, like there's not going to be that. 573 00:45:24,618 --> 00:45:28,598 So I think, yeah, I think that's a really positive aspect of it. 574 00:45:29,248 --> 00:45:30,218 You can change career. 575 00:45:30,288 --> 00:45:34,368 It's so interesting how many people, how they've got into software engineering. 576 00:45:36,278 --> 00:45:37,098 Tim: Yeah, I agree. 577 00:45:38,038 --> 00:45:43,538 I actually expected you to say something slightly different, if I were to look at what 578 00:45:43,538 --> 00:45:51,838 you're building, I would describe you as an entrepreneur who is using software, essentially. 579 00:45:51,848 --> 00:45:59,618 Like I'm surprised that your personal emphasis is on the code rather than the company, let's say. 580 00:45:59,988 --> 00:46:06,598 Um, however, it's fascinating to me that that's how, that's kind of the mantle that you've chosen to wear. 581 00:46:08,198 --> 00:46:10,228 Caroline Morton: Yeah, it's the one which feels most comfortable. 582 00:46:10,518 --> 00:46:16,618 I just can't ever imagine or describe, I just, I just cannot imagine ever describing myself as an entrepreneur. 583 00:46:17,428 --> 00:46:18,918 That seems, I just cannot. 584 00:46:20,188 --> 00:46:27,638 Um, but, but yeah, it's, uh, I, I, yeah, I'm enjoying wearing the software engineer mantle for now. 585 00:46:27,638 --> 00:46:28,508 So, or 586 00:46:28,903 --> 00:46:29,533 Tim: Yeah, superb. 587 00:46:30,353 --> 00:46:37,533 No, it's absolutely, again, I, I don't know whether anyone will do, does one wear a mantle? 588 00:46:37,533 --> 00:46:38,783 I'm presuming, I presumably 589 00:46:38,928 --> 00:46:39,328 Caroline Morton: I don't know. 590 00:46:39,328 --> 00:46:40,738 It's why I changed it to label. 591 00:46:40,738 --> 00:46:43,118 I was like, do you wear a I'm not sure actually. 592 00:46:43,118 --> 00:46:44,388 So, um, 593 00:46:44,503 --> 00:46:45,373 , Tim: but, um, 594 00:46:45,488 --> 00:46:46,658 Caroline Morton: comments correcting us. 595 00:46:46,658 --> 00:46:47,483 So, 596 00:46:47,608 --> 00:46:47,838 Tim: Yeah. 597 00:46:47,838 --> 00:46:49,598 I, I, I, I'm looking forward to it. 598 00:46:50,453 --> 00:46:53,383 I heard you are involved with Women in Rust. 599 00:46:54,978 --> 00:46:56,328 What is Women in Rust? 600 00:46:56,648 --> 00:47:05,618 Caroline Morton: So Women in Rust is a community group that I set up with a, uh, another person called Lizzie Holmes, who is head of operations 601 00:47:05,638 --> 00:47:12,418 at SurrealDB, which is a database company that's built in Rust, multi modal database company. 602 00:47:12,758 --> 00:47:18,198 Um, and so basically we've set up, um, this Women in Rust group. 603 00:47:18,508 --> 00:47:22,278 It's currently a meetup group, and we just started in, I think, April. 604 00:47:22,568 --> 00:47:23,798 We had our first meeting. 605 00:47:24,518 --> 00:47:25,108 meetup. 606 00:47:25,308 --> 00:47:28,748 Um, and we've already got 190 members. 607 00:47:29,608 --> 00:47:32,848 Um, and so that's been really positive. 608 00:47:32,888 --> 00:47:35,998 We've had some education, uh, lectures. 609 00:47:35,998 --> 00:47:41,728 The first two were me and then we've now, I'm delighted to say, we've got external people now coming in. 610 00:47:42,038 --> 00:47:48,143 These amazing female role models who can come and talk about how they're using Rust to build their business. 611 00:47:48,183 --> 00:47:52,503 And we've, you know, we've had people who Rust is their first programming language and then 612 00:47:52,503 --> 00:47:56,683 people who are super experienced in other and they've come from sort of different backgrounds. 613 00:47:57,093 --> 00:48:02,553 Um, so yeah, if you are interested in Women in Rust, you can join the meetup group and 614 00:48:02,553 --> 00:48:08,343 there probably will be Slack or some other form of electronic communication coming soon. 615 00:48:08,393 --> 00:48:09,843 Uh, once I figure that all out. 616 00:48:10,063 --> 00:48:10,693 Um, 617 00:48:10,978 --> 00:48:15,588 Tim: Is it specific to London or at least the southeast of England or? 618 00:48:15,683 --> 00:48:21,333 Caroline Morton: so it's an online, so we always run, um, yeah, we always run online versions of the event. 619 00:48:21,343 --> 00:48:26,653 So actually we've only had one in person meet up, everything else has been online. 620 00:48:26,723 --> 00:48:37,123 And so we run this monthly lunch at, uh, what's it called, Learn at Lunch, and, um, that's, you know, an hour over the lunch break every week, 621 00:48:37,393 --> 00:48:42,603 and not every week, every month, um, and that's been really fun, really friendly community. 622 00:48:42,993 --> 00:48:49,683 Um, and that's recorded and is put on YouTube and sort of various different places for people to watch. 623 00:48:50,148 --> 00:48:51,508 later if they want to. 624 00:48:51,928 --> 00:48:59,018 Um, and then we also have just started like a community kind of catch up, um, as well, that's new for us just to sort of try and encourage 625 00:48:59,018 --> 00:49:02,778 people to introduce themselves, talk about who they are, why they're interested in Rust. 626 00:49:03,488 --> 00:49:10,918 Um, and we're going to be running some workshops in September on APIs and hopefully some other stuff next year. 627 00:49:11,298 --> 00:49:16,268 So yeah, very grateful for Surreal Database Company, a DB, Surreal DB for sort of 628 00:49:16,288 --> 00:49:21,648 being, providing such a lot of, um, support to us and, and Lizzie's amazing. 629 00:49:21,648 --> 00:49:23,098 So you should definitely talk to Lizzie one day. 630 00:49:23,098 --> 00:49:24,968 She's a real advocate in the space. 631 00:49:26,068 --> 00:49:26,618 Tim: I shall. 632 00:49:26,648 --> 00:49:28,318 Well, at least I'll go and nag her 633 00:49:28,668 --> 00:49:30,758 . I have a question 634 00:49:31,788 --> 00:49:33,108 Are you doing a PhD? 635 00:49:33,708 --> 00:49:37,538 Caroline Morton: I am doing a PhD, a very part time PhD, but don't tell my supervisors. 636 00:49:38,058 --> 00:49:46,268 Um, so I'm doing a PhD in, we haven't talked about this, um, but I've also had a bit of a career as an epidemiologist. 637 00:49:46,308 --> 00:49:48,528 I actually did it before I trained as a GP. 638 00:49:48,528 --> 00:49:49,188 I was, did. 639 00:49:49,428 --> 00:49:50,258 epidemiology. 640 00:49:50,738 --> 00:50:04,848 And so I, yeah, I've been involved with it for sort of 10 plus years, um, or 10 Um, and eventually I've taken the, um, sort of bit in 641 00:50:04,848 --> 00:50:13,388 the bullet, I suppose is the phrase, and, um, doing a PhD, um, at the London School of Hygiene and Tropical Medicine in medical statistics. 642 00:50:13,848 --> 00:50:18,088 Um, and my PhD is on creating synthetic data. 643 00:50:18,088 --> 00:50:25,348 Um, for realistic synthetic data for electronic health record research, which is pretty niche, but really important. 644 00:50:26,608 --> 00:50:32,108 Tim: No, I, I want to kind of scream because this is sort of slightly incredible. 645 00:50:32,108 --> 00:50:34,648 I've, I'm, it's unfortunate that we're right at the end. 646 00:50:34,688 --> 00:50:39,408 I, um, I want to talk to you about record linkage actually. 647 00:50:39,668 --> 00:50:45,538 Caroline Morton: Okay, it's something I've thought a lot about and I've been very frustrated with in the past. 648 00:50:47,588 --> 00:50:50,778 And I think it's easiest in the UK, actually, of anywhere. 649 00:50:50,838 --> 00:50:54,458 Um, you know, I think we've got a very good setup for linking records. 650 00:50:54,498 --> 00:50:56,668 Maybe not the easiest, but it's sort of up there. 651 00:50:56,938 --> 00:50:59,658 And even then it can be a frustrating experience. 652 00:51:00,078 --> 00:51:00,098 So 653 00:51:00,223 --> 00:51:01,483 Tim: I bet, I bet, I bet. 654 00:51:01,483 --> 00:51:05,943 Well, I shall let you go and have a really, uh, and please do have a pleasant day. 655 00:51:06,303 --> 00:51:09,713 Um, how has summer been, by the way? 656 00:51:10,023 --> 00:51:12,343 Has it been heatwaves and disgusting heat? 657 00:51:12,423 --> 00:51:12,943 Or, 658 00:51:13,218 --> 00:51:14,908 Caroline Morton: it's been distinctly not that. 659 00:51:14,908 --> 00:51:15,848 It's been a lot of rain. 660 00:51:16,058 --> 00:51:18,528 Um, but it's. 661 00:51:18,923 --> 00:51:23,883 Yeah, I mean, we've had a few days of sun, so it's been, been nice to have that. 662 00:51:24,493 --> 00:51:28,443 Unfortunately, I managed to get COVID during the time I was meant to go on my summer holiday. 663 00:51:28,453 --> 00:51:31,203 So I did not get to go to Portugal, but nevermind. 664 00:51:31,243 --> 00:51:34,393 Um, we have had a few sunny days since then. 665 00:51:34,393 --> 00:51:34,513 So, 666 00:51:36,643 --> 00:51:36,913 Tim: okay. 667 00:51:36,933 --> 00:51:38,833 Hey, well, it's been a very sincere pleasure. 668 00:51:39,243 --> 00:51:40,353 And, uh, thank you so 669 00:51:40,473 --> 00:51:41,273 Caroline Morton: thanks for having me. 670 00:51:42,093 --> 00:51:42,343 Tim: Cheers. 671 00:51:42,943 --> 00:51:45,003 Um, I shall push stop.