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I'm listening every time. Well, welcome back, everybody. I hope you're refreshed and to everybody online. I hope you managed to get yourselves a coffee too. So this is an open session now, er, for the next sort of half an hour or so. Um, we have a panel here, I'll ask each of them to introduce themselves and say a few words about their background. You've, you've met, er, Richard Kerr and er, Matt Harris already this morning and in the center of our group on the stage, we have Mrs Anita Shaker who's a council member of the Royal College of Surgeons of England and chair of the SA S forum. She's a maxillofacial surgeon in Dundee. And then we are pleased to welcome two visitors to the college, Professor Nick Cooper, who is the president of the Academy of Medical Educators. And if I can just put in a plug for that organization, which has several surgical members and is open to doctors and surgeons of any specialty. And then we're delighted also to welcome Doctor Neil Ralph from health education England. So, the floor really is yours. Now, both literally here in the room and online we're happy to take questions, comments, points for discussion on any aspects of surgical training and education. Um We can't do politics and every other thing that the college is involved with this is an education day. And um we'll take any questions or comments or points for discussion on education and training matters that you can put to the panel now. So if anybody in the room wants to raise their hand to have a microphone, that's fine, Louise will take the questions from our online delegates. Please type it into the chat box and if I can ask the panel one by one to just give a two minute introduction to their role in surgical or medical education and the areas that they think are a challenge for the future. And we start at this end. Mat we've heard a little bit from you already. Do you want to say a little bit about your work beyond the test? Um Yeah, of course. So um yeah, I'm I'm Matt as you know, um I'm general surgery trainee and part of the association of Surgeons in training as an honorary secretary. Um in terms of what goes kind of beyond um the future of surgery. Um I think it's as we kind of highlight in, in the second slide, um having this multifactorial kind of reduction in training time is what we need to address and it may not necessarily just be technology whilst it's interesting. Um It's about kind of getting everybody on board and making sure that every kind of case is, is considered as a training case and um having all trainers kind of consider making sure that, you know, trainees are 100% involved in, in training at the time. Um Thank you, Doctor Ralph. Thank you very much. So, I'm Neil Ralph and I have the pleasure of leading what we call our technology and heart learning team, which was health education England now part of NHS England as the organizations have, have um come together this year. My um tell team as we affectionately call it focus is on how can we support education and training in its broadest sense into health and care often to be able to evolve, to adapt, adopt education of 4.0 the latest in terms of being able to bring in evidence based um adoption of new or innovative or existing technologies and to understand the implications of the impact of those technologies in the way we then deliver education. And how do we back that up with evidence based educational science as well? Lots of the concepts that map very, very wonderfully presented on earlier. So we work across all professions, both in terms of the future workforce, well, of our existing workforce across all the roles. And um we've been linked to Matt and Josh, for instance, with regards to the test report and it's wonderful to see the ongoing influence of the future of surgery report. We're very excited to, to be assistant partner with the college. There's a huge opportunity in terms of how we can evolve education and training for our, for our surgical colleagues. And we want to very much be part of that journey with you. Thank you, Professor Cooper. My name is Cooper. As you've heard already, I'm actually a professor of clinical education at the Peninsula Medical School. And actually, although my background is in primary care and pediatrics, I had a long standing association with the college and just reflecting on to a few minutes ago, I was involved in the sort of training the trainers program back in the 19 nineties when we started with flip charts and overhead projectors and powerpoint was a thing of the future, you know, this new technology was coming in etcetera. So, you know, 30 years on because I know it's um basic surgical skills 30th anniversary this evening, how things have changed and evolved. And I've had long standing involvement with the college over many years with training, etcetera. Um I'm obviously involved in training at all levels of undergraduate and postgraduate and in terms of the academy of medical education, which had a kind plug. Thank you very much. Um It's actually based at Cardiff Medical School was founded in 2006 and is an accreditation body with professional standards for all educators in medicine, dentistry and veterinary science. It's now a public professional register, which is recognized by the GMC as meeting training standards. So by being a member or fellow um and keeping up your registration, it's being recognized by GMC as keeping good practice. And obviously, our role is to try and support educators in the future. And I think the challenges that have been outlined in the educator workforce strategy published by A G in March, raise the issues about time for training. How do we support educators in their role? How do we support educators who might want career development in that particular aspect of their work as opposed to research or even aspect of clinical practice? Um And, and that's where we, we fit as sort of hope for the shaking policy as much as we can. Thank you, Mr and thank you very much, I'm Nita Sheer um International medical graduate. I graduated initially from India. My D background is dentistry by but I work in a speciality that's regulated by GNC. So I had to embrace the discipline of General Dental Council and General Medical Council and I was always subject to double jeopardy because I was registered with General Dental Council. So I went to Cardiff Law School and did my LLM in medical law. So that kind of sent me to Cardiff Law School and it has been endless opportunities since being registered with the General Dental Council. I still work in a speciality regulator at my General Medical Council. I am GNC recognized trainer. I think I am the only one in the country. Um I am lead for all SS doctors, surgeons, and dentists for all four nations and I chair not just the s forum at the college, but also at the Academy of Medical Royal Colleges. So my aspiration always has been equal opportunities for A S doctors because obviously we do get forgotten in the workforce crowd. We are always left behind. So I'm looking always looking for opportunities that could be open to the S SAS doctors as well because they are underutilized part of the workforce. They are trainers, but they're not really necessarily recognized, their trainers, they have training needs, but they don't always get to have the training same way as the trainees. But interesting thing is with portfolio carriers which we hold and which we aspire in that we are looking at portfolio carriers for trainees. And actually in reality, we see that is the carrier, the current consultant force has because they're all subspecialized in a narrow field of practice while you have done your training for six years or more. Um after a few years because they've been working in one small area, you have lost your competencies. And I see that read in my own speciality that oncology surgeons are on call seven days a week if there's a flat patient in the ward, because others cannot take the patient back to theaters. However, us as being specialty doctor during second on calls, which we are much more robust in management of those patients because we are facing those patients every single day during our on calls. So that kind of inspires me to say we are actually good enough to be considered as equal partners in medical workforce. And that's my aspiration. And then Mr Kerr, we've heard from this morning but say a few words, um background in education. Uh OK. So um my uh exposure to medical education started in the eighties. And the model of education at that time was an apprenticeship. And I worked with a small number of senior colleagues who basically took me under their wing and said we can train you, but sign this contract first. And my contract was to work 127 hours a week and that I did for five years as a training program. Now, the experience of that told me that there has to be another way of gaining uh a surgical education. Um And so it's been a huge privilege for me at the latter stage of my career to, to see that there, there is another way, there should be another way and there can be another way to train our future surgeons and surgical teams of as we go forward, I guess my, my concern however, was, and Andrew Stevenson put this beautifully just as we were coming in the room. Um was that we, we are facing an elephant, whether the elephant is climate change or the need for changes in surgical training and we can't, er, eat the elephant in one bite. We have to nibble at the elephant. And I guess the question is, is, are we nibbling in the right way? And what do we need to do to, to ensure that we are doing that? And with our educationists in the room and on the panel, are we nibbling it in the right way to ensure that the changes that we want to get out of it are going to be the right changes. So I, I guess I come to this with a series of questions rather than, I don't know what the answers are. But I, I kind of feel I know what some of the questions are. Um And I'd quite like to kick off the questions by actually putting that question to the panel, which is, are we nibbling this in the right way? And how do we make sure that the outcome from our nibbling will take us to where we want to get to as president of the Academy of Medical Educators. I'll go now. Ok, perhaps you'd like to kick off with this. I mean, I think it's difficult, isn't it? Because I think there are so many different things happening in the world generally as we've heard, but also in the NHS and in surgical training, also the actual trainees themselves being used to new technologies of learning in addition to surgical training. Um, and also got to think, we've got to think about, you know, we're moving beyond generation there. The next generation that we're seeing coming to medical school now are completely different in terms of the way they're accessing information. They're already using A, I, we've still got that problem and, and certainly undergraduate education of, you know, how robust is what their learning is about because they can go to A I and produce stuff, et cetera. But equally, they're going to have tools that are probably beyond my comprehension about what they're going to be able to do in the next decade. So it's not, I think it's not just thinking about now or in the next few years, it's what's going to happen in the next decade. I think maybe I can jump in, you know, we, I think we're all appreciating. I suppose people appreciate we are really going into a new industrial revolution, a new industrial age. And um with some incredibly, you know, critical challenges as, as we heard before the coffee break to, to address as part of that, this new industrial age, this digital, this digital revolution is coming with, I think new, it's, it's forcing us to look at how we go about solving our problems through, through different lenses. We're applying new frameworks. We know that the ongoing evolution of digital technologies as they just just described will mean that in 5 to 10 years, time there will be, we'll be able to do things we can't necessarily well conceive right now. So we are starting to think about our problems through, through a more agile mindset, through an iterative process through being much more user centric in design. And that's ubiquitous across industries. Now, in terms of how do you ensure you are better able to solve your problems as quickly and efficiently as possible. So that's understanding the needs and requirements of those individuals at the receiving end of whatever intervention you're putting in place. So that's critically important. And I think we bring that together in my mind with the fact that what we need to hold on to is the consensus of expertise that we've got the incredible rich, diverse amount of knowledge, skill and vision that exists in the global community, but also in our, in our, you know, in our health and technology interface community in England across the UK as well. So if we apply that mindset and if we make sure we hold on to the assets that we've got at the moment, that's what's gonna give us what I like to talk to my team about the sort of conditions of success. Um Does that make some sense? Yeah, that makes a lot of sense. Thank you. A lot of sense. Yeah. Well, I think what, what I would add from a trainee's perspective um is we've talked a lot about today about new innovations and how can we change surgical training for the better? Um But I think it's important sometimes to kind of take a step back and address things like trainee burnout as a barrier to surgical training. Um You know, we could potentially make more progress even even by addressing that. What, what's, what is the problem, the structure of training programs even themselves, you know, there's been a lot of discussion around rotational training and how we can kind of optimize things like that. Um And I guess, I think one thing that's really important whilst this is, you know, not an answer to um are we nibbling the elephant correctly? It's making sure that we have trainees of all different groups who are affected in different ways by decisions um Invested in kind of all stages of the decision making process if things develop. Um I'm going to talk from the educator point of view. Um I think there is a gap when we start introducing this modern technology. We have to remember we have generation Y and now that generation, you know, there are generation which is very, very fine um surgeons with hands, whereas the V generation is tech savvy and now there's a Z generation which is machine savvy and we need to find a balance, not everything is for everyone. So focus I think should be prioritized very early in the carrier. And for me, it should be right at the med school, introducing all these technologies and ideas, artificial intelligence, human practices. Because when the trainee come into the clinical workplace, it's so overwhelming all this information. I think there's a lot of confusion in the carrier, what they should be doing. And I think when they decide either it's too late or um sometimes we make the wrong choice. So I think introduction at earlier level at all these things is um, should be a priority. Certainly the undergraduate curriculum, which I'm sure we'll talk about at some point during the day has introduced some of those changes as a core component of of that. Um when that will get into the post graduate curriculum, um obviously it takes time. But yeah, II, I think a general issue is something you mentioned earlier about the humanity and, and the contact with patients. And in the early days of simulation say I was involved in some of the research around that 20 odd years ago and it was a concern that you could do things in a simulated environment. But how easy was to transfer that in vivo to environment. And it was obviously an adjunct very much in that stage. But technology is predominantly doing the educational stuff. It's about that transference and the real workplace and that linkage at the same time. And as we've heard, you know, many patients are only been seen virtually as well. So it's how all that balances out, I think in the future, I think we've got a question here because we have a microphone for BJ. Thank you. That's something we just saying. I, a vascular surgeon as well as on being on council, it may have changed tack a little bit and we're talking about the future of surgical education, but that clearly depends on there being surgeons to train out of every six applicants for medical school, five are rejected. The government has proposed in their workforce plan that they're going to have apprentices and other such and then taking it further on, we have physicians, associates and at the moment, they're getting a fair amount of funding from the NHS for their training, but also for courses that they go on. And I'm sure many of the trainees here would grasp those opportunities for funding for courses they have to struggle to get at the moment. So I'd really like some ideas about that because that is clearly the future of surgery as well. The extended surgical team or the extended medical workforce and the workforce plan. I think we're all tied in together. We have another how to approach. Um I'm the chair of a pa school council actually for the last three years. Um I'm I'm going vice chair now. Um And obviously there's been a big push by government around physician associates, but I think the problem with it was that the development hadn't reached a critical point and then COVID hit. Um And so we're still through this whole regulatory process with the GMC as well. And I think until that's sorted, I think we then have to sort out how it maps out their careers with doctor training and everything else. And I think I would take your point about the apprenticeship models. We seem to be getting push from universities to run more and more apprenticeship programs. Um, and that, that again is a sort of whole mine field of what that's going to create. And we're not quite sure. I mean, I think the expansion of medical school places generally is probably a good idea because I think what it hopefully will do is widen the um participation of different groups of people who are hitherto, perhaps haven't gone to medical school. And we heard that perhaps people coming in with different skill sets rather than traditional skill sets. Um But obviously, that also means we have to train them as well alongside our post graduates and everything else. So it's just an impact at every level. I think I have a question, Andrew Stevenson, orthopedic consultant to pick up that specific point is the entry point to med school at the moment is purely an academic one. And it doesn't take into account different skill sets, personality types, attributes that are required to be a successful doctor and surgeon. You know, we all as was mentioned, also just earlier, there are lots of different skills that make up good surgeons and you know, there are lots of different types of good surgeons. How or is that conversation being had with the medical schools as to, you know, not necessarily a three, a star candidate for every single medical post we don't want, we don't want a striker, you know, in the parlance for football, you don't want 11 strikers. You need a goalkeeper, you need a back four, you need a midfield and you need the attack. Um, and at the moment, we're just choosing the same um the same time. No, I mean, I agree entirely and I think that's a conversation that the medical schools council needs to have with the medical schools and especially the new medical schools coming on board as well, looking at those admission criteria. And I think, you know, there is a basic admission criteria that traditionally was around a level grades, but, you know, they're probably not that meaningful anymore to say that perhaps a bit unfair, but, you know, they are perhaps less meaningful than all these other skill sets. And I think that's what we have to look at. I mean, one of the things that we've had locally is a foundation year and that has brought in people with lots of different skill sets because they haven't had to have the academic requirements to enter that foundation year and provided they achieve the foundation year, they then move on to the ordinary five year medical program. So I think that's one way of expanding it and looking at different skills and different ways of working. I think we have a question coming online. Yeah. So, um along the lines of, of what we've been talking about. So given, um, I use the words here, scope CRE um and increased service provision. How can we ensure there are enough training opportunities for surgical trainees? Just an easy one. Matt, give us your wish list and then we'll ask the senior members how we're going to deliver it? How much time have you got? Um I think um it's kind of two fold, I guess. Um it's about kind of building really robust surgical teams within the spectrum of the extended surgical team. So we kind of we've touched on um how trainee surgeons and physician associates and amps can work kind of synergistically together because there's obviously some brilliant kind of enhancement of these allied professionals can bring. But also there are some challenges especially in um what can, you know, a rationing of surgical cases. Um And I think it's important to be clear about each individual roles, whether that's on a kind of a department, departmental basis or whether it's even on a national scale. Um But kind of in terms of making the most of our reduced training time, we talked about it this morning. This is where some of these interventions that that they can come in. Um helping kind of more junior trainees um get up that learning curve early making sure that they're able to access good quality simulation as it's available, making sure they're able to access kind of this Telep proctoring um that is available and um even in the undergraduate um kind of curriculum, um I think sometimes you can get, you gain even more value in this is hopefully what we'll find from the augment study that we talked about um than being stood on the, the edge of a theater. Whereas actually you can sit on, you know, an online session, but actually, you know, with a screen, it can be an as things are going along, you can ask questions with without having the the individual personal stress of being in a theater environment with a million people around. Um I think combining kind of these technology enhanced um interventions together can help kind of get make the most of that kind of lack of surgical cases because it's not necessarily something that is, you know, a quick fix of saying let's just do more operating. Can I say? Um I absolutely agree. I think the leadership model we need to demonstrate at in individual department level. And what in my vision I would like to see is trainees are mentors for physician associates and other um support staff because that gives them an opportunity to learn and then teach. So their mentors, they are being trained into the educational supervisor roles or clinical supervisor roles. And at the same time, they're taking the lead for physician associates and other extended surgical team members where there is a certain level of respect for trainees. They are not just trainees who need to learn, but they're also mentors and trainers for that specific group. So I think it's a local leadership that needs to be demonstrated that actually extended surgical team can work very effectively in a very nice way. We have got huge waiting list. That means there's a huge training opportunity out there and that needs to be utilized effectively. Thank you. Um We have a number of questions now. Hands going up in the room, a lady in the green jacket there. Thank you De Bo sc chair and trauma and orthopedics. Um It's a really a follow on from that question. Um So one example, I, I loved your slide, by the way, mat of all the things that reduce training time, I may well steal it. Um um But bearing those things in mind and giving you an example from my own specialty where when we analyze the log books, we see that there is a 24% drop in numbers compared to 2019. I'm not suggesting that COVID is by any means the sole thing that's responsible for that. But really what I'm asking is what are the concrete ways that we can address this? So there are things that we can't control and then there are things that we can control and all the hashtags as you say every case of training case, no training today, no surgeons tomorrow. We know the hashtags but what do we do to help those things to happen? How do we make the hashtags happen? Yeah, good question. Um I think um one really good example um that we spoke about just before is is making the most of each training case. Um And I think it's really easy to kind of go to work, you know, have a trainee involved in a case, whether it's a couple of hernias or a couple of kind of knee replacements or whatever orthopedics do. Um We're all asking that question that I, um and it's easy to kind of go along with it each case, I think, isn't it? Sometimes? Um But actually if you really set kind of the precedent beforehand with your training, be really clear about what you're expecting to gain, um, what potentially may go wrong, how, what you can get out of the case. Um And then, you know, then have this kind of follow up debrief to make the most of your ability to reflect from each case. You go from, you know, having done two or three cases, but you gain the same skills from just, just a single one because I'm sure, you know, as training surgeons, you have a couple of cases, sometimes the list is amazing and that's where you really suddenly jump up that learning curve. But then you have a load of lists that you can bumble along, you're not really learning much and I guess from a, from a trainer point of view, um, having trainers who really kind of engage in that process and I know it's difficult because obviously that requires time as well. Um, but that's one thing I think as a, as a, as a step that we can do that doesn't cost money, um, from a, from a training point of it's really valuable. Um I think that there is a need to have er thoughts about training, uh integral to all of the decisions that we're making about the delivery of service until we can get to a point where the pressure to deliver service is, is in some way matched with the need to deliver training, then we're going to continue to have those problems that you're describing. So for example, um we heard last year at the future surgery conference about fast track day case hip and knee replacements, all of which are being done commissioned by the health service and being done in effectively private institutions by um consultant orthopedic surgeons with no access with trainees have no access to that at all. Um And it was a fantastic service. Don't get me wrong. It's brilliant. I absolutely get that. But what a training opportunity as well that's going missing. So why couldn't the contract when that was negotiated in 0.4 was? And the training will be whatever it is that every fifth case is done by a trainee under our supervision or every fifth day is a training day as opposed to a pure service delivery day. And, and until we can get that absolutely embedded in our service delivery, I think that the catch up is always going to be really difficult because the pressure at the moment is to get rid of the wait list. You know, there's 7 million people waiting for operations. We've got to get rid of the wait list. But Richard is that not where we are, senior surgeon should actually be taking a stand. I know we had this issue with COVID. Um, they outsourced, you know, one of the local private hospitals, our work and initially they said, oh, no trainees, et cetera. And we just said, fine, we won't come, you know, we come and the trainee comes with us, you know, assuming they're not on call or whatever. And basically it just meant they had to check the CB and AD BS check of the trainee to make sure they were ok. Get that has to be across the board, has to be, but we have to take the lead on that to say, you know, it comes as part of the deal. I come with my trainee um because we're a package essentially. Yeah. Yeah. Yeah. Yeah. And gentleman back has been waiting ages to speak right at the back there. Um Hello. My name is Eamonn. Gui, I'm a pediatric surgical trainee in London. I've got two questions and hopefully brief ones. The first one is about um equitization. I think Matt you mentioned about trying to make sure that um the quality of surgical education that you provide in different centers is equitable throughout the UK. I just want you to expand maybe a little bit more about the practicalities of it because I appreciate it's a big challenge but you can um you can see clearly that there is a big division between how people are trained and how they qualify as consultants. And then when they get to work and their centers as consultants, how that affects patient care as well. Um The second question I've got is about accountability. I appreciate that there are different levels for an educational program or like for, for the future education in surgery starts by organizations and curricula down to trainers, down to the methods of education, down to the trainees themselves. But I want to address the accountability part of it because the big drive of it is the trainers, the support that they get and their engagement and that can impact the process massively because you can have a perfect curriculum, you can have a perfect system. But then if that is not delivered, then the whole process is hindered. So I just wanted to ask you about your thoughts about the subject. Um So I'll, I'll perhaps make comment on the first question about equitable, I guess. Um, the only way that can, that can possibly be addressed if it's, if it is even necessarily possible is for these kind of changes to come from the top as, as a blanket through, you know, the curriculum and the way that we, we train trainees between, even between specialties, you know, we talked about, um, what's included in each single specialty curriculum. Um, but, but it's difficult, um, each different hospital has different infrastructure, certainly, even I, you know, I've tried to employ some of these things like um video libraries and um Google Glass and things like that. Sometimes your hospital structure doesn't have the right wifi. Um So it's a real challenge. Um And other than saying, you know, having good leadership from our kind of trainers across the board um is difficult to answer. Um Would you like to comment on the accountability side of things? Oh, I mean, you want equity and in a sense, do play into each other they come through in a sense and they absolutely do. And I think there's a few things here. One is um the publication of the long term workforce plan and the challenges that it took to get to that point is a really important kind of marker in the sand for us all. Here, there is a huge amount of work to do and it's going to be hard and complicated. But, but, but that now being published and out there with commitments behind it starts to give us a firmer stage to launch ourselves forward from linked to that. They mentioned the educator strategy, for instance, what are we doing to make sure that we are supporting educators and we are making that, you know, is attractive to others to become educators going forward. I think that's a good document. There's lots of opportunity that's coming from that and it's linked to the long term workforce plan. Um Bits of work that my team are tasked to lead on that are actions with the long, long term workforce plan include how we are building greater communities of practice around virtual and hybrid learning and how we are making sure that those educational methodologies pedagogy are adapted and utilized effectively and evolved, fit for purpose for surgical education again. But we want that skill and knowledge and confidence of delivery equitably achieved across the country, similar links of simulation as well. Link to that I would say is also coming through to the joining together of teams working in it and in, in, in leading on digital and working in hr and OD within organizations. And we're having those conversations where we're trying to bring people together. So what does, what does it look like to have an educational environment that is that enables you to deliver that technologically enhanced or enabled education and training. So you can start to utilize those video libraries, you can bring hollow lens or a VR device into your environment and it isn't going to be an enormous effort from medical education teams to get them to work because we've done the work already to, to start to create the, you know, make sure all the wifi is in place that's required. So we're rolling out something called the technology enhanced readiness and maturity model. And we've got about 50% of trusts have engaged with us and we're looking to make that 100% and it is that forum to bring people together because what you want focusing on is not solving your problems in your organization is knowing, how do you make sure that you're accessing the resources, trainers are skilled, you're getting access to multidisciplinary training opportunities or to virtually delivered training opportunities, you know, again, making sure every, every opportunity can be converted into a training opportunity live or to be watched subsequently. But that long term workforce plan actually sets a lot of this context and it, it will I think energize this conversation going forward not to say there aren't a lot of the challenges still to overcome. But um as much as it's happening at a point in time of significant strain and challenge, it is a really important juncture, I think for all of us in the room here and listening virtually. No, I think I saw another hand at the back of the room. Yeah, gentleman is there OK. We need the microphone. So that the people online can hear you. So, um Pranay, I'm um East end surgeon and um the clinical lead for the surgical skills program here at the college, we talk about training, but my question is this, all of us have gone through registrar training and then the next day magically, we're expected to become trainers. So what are we as the college and as surgical leaders doing to train our trainers to become good trainers? Cos I do not believe that actually anybody sets out to be a bad trainer. I think it's about equipping them for the tools to allow them to do the job. And I just would like to know what we're doing really? Because I, I'm not, I didn't get anything training wise um to become what I am Richard. Can I come to you on that? Uh No, I'm going to, I'm going to give you the director of learning who's going to give you chapter and verse on that. Hello. Um Thank you. Um Well, so I'm also going to slightly pass to the fact that we've had some questions online similarly that we've got a session later on about educational supervisors that will be picking up some of that we do, of course. And we are also remodeling our train, the trainers course. So if you want to speak to Sanjay about that at any point today, and Dan running our session later on on educational supervisors, there's a whole host of different things that we will be picking up at different points in the day today. There are, I mean, this is my particular area of um passion maybe. Um I think it is really important that in this whole conversation and when we did the improving surgical training project, we need to professionalize the trainer role. As much as we do talk about training, there needs to be that recognition and what we can do is the colleges support that lobby for it. Keep talking about it, bring it raise awareness and provide all of the resources and the abilities to be able to do that. But I think it's an ongoing conversation. It's time isn't going to magic itself out of nowhere, money isn't going to magic itself out of nowhere. We just have to keep talking about how it's really important that being a trainer is a skill in its own, right? It's a profession in its own, right? That goes alongside being a brilliant surgeon and in the interest of time, we just take one last comment this time, like just before that kind of, that's where the academy of mental educators I think comes in as both um for political lobbying about that. But, but building on the educator workforce strategy, very much that message about professionalizing the role, not everyone wants to be a trainer, educator and those that are need that support ongoing recognition and identity. If you like, there's been lots of research around the lack of identity for educators throughout the world. Um And somehow they, they're doing it out to the goodness of their heart very often and getting stressed and not doing that. And I think picking up your curve, it's great if people go up that curve, but if people stall on that curve, you really need much more supervision, support feedback, don't need time for reflection. All those sort of things. Sorry to inter sorry, justly consultant surgeon, a great question. Just picking up on um the previous question about preparing people to be trainers. I don't know if I'm reading this wrong. But two weeks ago, an E email went out saying uh from the college about a BS S female faculty preparation course. Now, I don't know who that was run by, but there is a palpable undercurrent of anger that females need a special course to be trainers. I don't know, maybe it was run by, but certainly a few people whom I've spoken to said it left a bit of a sour taste in their mouth that you know. Now on the one hand, it's great that the that the that the college wants to increase the number of female trainers. But I got to tell you the optics on that didn't look really good. And secondly, perhaps to maths and to the rest, greater engagement for, for technology, I think you guys need to be more visible on more recent platforms. I'm not talking about being a tiktok content creator but uh reddit and perhaps having a bit more, er, uh, having a few Eme sessions ma, you know, do you know, ee ba basically ask me anything sessions on Reddit? Uh There, there's quite a undercurrent on Reddit to understand what the trainees are facing nowadays. And there's a huge anger about physicians, associates. Uh I'm not gonna talk more about that but I'm just saying, uh I think we're missing a trick here as a consultant. I spend way too much time on Reddit on. It's fantastic. But the, the point being is that that there's no official presence there, youtube. Yeah. Acid is a youtube channel but there's like maybe 50 followers and 100 subscribers. Uh and the college May and the college puts out youtube videos as well. But I'm just saying, I think amongst the seniors and I'm probably considered myself a senior now. Unfortunately, we need to have more engagement. Um And also about the BS S female, perhaps maybe rebranding it as a course saying that, you know, you want to be more trainers, you know, women, you want to train what obstacles you face. Don't, don't give them a special course as if they need to make up to be traders. I think you raised two very important points. So we'll leave the last comment to Louise before we go to the breakout sessions. And I would just, I would personally like to apologize for that wording. I don't think that wording was right and I wasn't comfortable with it either. When I saw it, I would just like to reassure that it has really good intentions behind it. It is not that women need a special course to be able to be good trainers. It is that what we need is more visible equity in our, to start with our most, um, whatever the right word is are courses that are aimed at medical students, foundation students and core trainees, we need to be demonstrating at least 50% women teaching on those courses. That is the intention behind that. What we wanted to do was offer some professional development specifically to make that happen. I don't think we use the right words. I'm sorry for that and we'll work that one out. Ok. Well, we're just off to 12 o'clock now. So it's time to move to the breakout sessions, as I mentioned earlier, you should have on your badge, which session you're in. If you're doing the leadership session, you stay here. There are two online sessions which I presume mostly the online people will go to. If there's anyone in the room that wants to join an online session, you can do it from your own device and we can sort that out for you. And then if you're doing the virtual reality and artificial intelligence session, it's in the room just across the way. And if anyone's not sure where you're going, then ask one of the team. But if you can move to your breakout sessions and then lunch will be at one o'clock. Is it or thereabouts? 12 45? Ok. See you in your sessions. Thanks.