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Lovely, good afternoon. Ladies and gentlemen. My name is Ryan and I'm the Acid rightful Wessex and the incoming Apnea book lead. It's my pleasure to introduce to you the acid debate for 2023. And I'll start off by introducing our panel members and how we're going to be conducting the debate. So this year, the topic which will be coming up on the screen very shortly is that this house believes that there are no longer incentives to enter traditional surgical training pathways. So that will come up on the screen shortly. And what we'd like you to do is so this is a mentee meter slide, the codes right at the top. I want everyone to log into mentee dot com. And if you could just please submit your vote before the debate, and we're gonna be doing it after the debate to see if our panelists can change your mind. So to start off with, for the motion, we've got Kirsty. Kirsty is the Royal College of Surgeons of Edinburgh rep to asset and she in herself has described her as the eternal registrar. So could we have round of applause for Kirsty, please? Wonderful. And then against the motion, we've got Lola. She is a asset past presidente. Um, and a number trainee in London in plastic surgery. So, could we have a round of applause for Lola, please? And then also on the panel, we've got Mr Goldie here a he's a upper gi surgeon in Brighton and we'll be providing the consultant voice on the topics around applause for him, please. Fantastic. So, keep boating. Um And this will be stay live until the end of the debate and then what we'll start off her shortly. So first we're gonna have Kirsty speaking to us about why she thinks there are no longer incentives to enter traditional surgical training pathways followed by Lola. And then we'll get um goldies away in on the opinion and they were going to open it up to the audience for you to ask questions for our panel members. Okay. So keep the questions coming as this proves to be an exciting debate. So Kirsty take the floor away, please. I will have, I'm gonna Rome. Um It's easier. You need to let you hold yourself up after last night. I've got my notes on my phone because it means I can make them bigger from a poor eyesight. And ladies and gentlemen, President's as one of the oldies at conferences like these, there's a traditional conversation I often find myself having with consultants, professors, president's of colleges and it's usually when we're watching some of the foundation doctors or medical students present their work. We all agree that we would never get into medical school today such as a high standard of the medical graduates that we meet. Now, whether this is true or not, I don't know, but one thing is definitely certain, not one of us would manage to get a trading post today. In this today's system, the process of submitting often random bits of evidence onto the oriole system means that you have to start working towards a career in surgery about the age of 16. Now, I don't know if you, if you were anything like me as a 16 year old, but career planning was not high on my agenda. In fact, not much was high on my agenda unless it involved a 16 year old boy by digress. So once you've gathered all of this evidence to show your dedication to a career in surgery, the powers that be are they're gonna move the goalposts, okay. And you're gonna have to sit with little notice. You're probably gonna have to sit an additional exam which has little relevance to your career that you've spent so long preparing for. But don't worry, it's an exam that you don't have to revise for said no surgeon ever. And if you are successful in getting a core training post or a national training number, you're gonna be arbitrarily placed in a in ordinary by a T P D that likely has no knowledge of your individual training needs or your personal circumstances. And that will probably be the opposite end of the degeneration, the job that you have next year or even in six months time. And I'm sure my colleagues going to tell you that you being a trainee gives you stability. But in the 12 years that I have spent in Dina reapproved training programs, I have worked in 13 different hospitals, that's 13 different Rotas and 13 different units in which I've had to develop the trusting relationships necessary with my colleagues and trainers to get the train, to get them to meet the training needs that I have. It has been far from stable. Meanwhile, my local employed colleagues have stability staying in the same hospital for many, many years with a team around them that no all of their needs, their weaknesses and their strengths. Now, some we may say that being an S E S or a locally employed doctor is like in a less good unit is far from ideal, but a non trainee can vote with their feet and move elsewhere without having to battle a training program director or the scenery bureaucracy. And whilst trainees do have guarantees of employment for the duration of their training. Locally employed doctors are still protected by UK employment laws which are actually some of the most robust in the world and they get to negotiate the terms and conditions and pay which said and, and get a job that within reason serves their individual needs, whether that's personal or professional. And the J C S T and co we're going to tell you that the new curriculum is more flexible to meet your individual needs. But in practice, that's not really true. Plus, like me, you can spend 10 years taking all of those boxes only to have the curriculum changed right at the end of your training and 50% of what you've done doesn't matter anymore. And here's a whole new set of boxes that you've got to tick. And while the see I'm with the Caesar process and being more defined and more accessible than ever, you can join the specialist register at a time and in a way that better suits you. But all of this assumes one thing, guess what, not all of us want to be consultant surgeons. Hence the eternal registrar R S A S colleagues are some of the most vital parts of the NHS. And who really wants to be responsible for attending management meetings or dealing with complaints and being an S A S doctor gives you the flexibility to work in a way that you want, pursue other interests and, and have a portfolio career which has never been more popular. And this is all without the additional cost that comes with being a trainee as you travel from one end of the diary to the other end of the diary and attend courses that are mandatory but never seem to be entirely covered by study budget. And you're s a s colleagues are better represented than any than ever before. They sit on college councils, they sit on exam boards, they sit in higher positions so their voices heard just as strongly as the trainee voice. So whilst there may have historically been many good reasons to be a trainee. These trains, these reasons seem to becoming, becoming less and less relevant to today's medical graduates and our future surgical workforce. So this house strongly believes that there is no longer an incentive to enter traditional surgical training pathways. Thank you very much. Thank you very much. Next, we'll be moving on to Lola who will tell you why you need to enter traditional surgical training pathways. Lola, please take it away. Yeah, very much. Hi, I'm Lola. So when I, when I was kind of told that I'd be arguing against the motion, I thought I'd drawn the short straw, but then I had a look at, I've had a look at the actual motion again. So this house believes that there are no longer any incentives I added any to enter traditional surgical training pathways. Then I realized I've actually got the easy job. So I my disclaimer is I'm someone who hasn't entered to training programs. I did call surgical training and, and a plastic straining at the moment. So, um I understand the sentiment behind the motion that, you know, training is terrible at the moment. Curse is giving you all the reasons why. Um it's difficult. Maybe you don't want to do it, but there are no longer incentives and traditional surgical training pathways. I think there are a few. So I think it's all about peace of mind, geographical stability. So yes, you can choose as a locally employed doctor. You can choose which hospitals you work in. You can choose when you go, you can stay in the same hospital. You can get to know everyone. But what happens when the scenery send an extra trainee and they have to reduce the number, the number of posts they've got. What happens when the man just decide that they need to downsize the department. If you, if you rely on a salary, then you need to just take a job wherever it is. So if you're, if you're in a training program, you know, you might have to strep all over around London, you might just slept all around Scotland. But you know, you've got a job and you know, you can keep going. Um So, you know, you're gonna be in, in one place for 2 to 8 years. That's, that's the piece, that's a bit of peace of mind. So we've got CCT CCT your certificate of completion of training. It's invaluable, it's recognized all over the world. And yes, you can use a Caesar route, but all of us really know in our hospital, you've got that one doctor who's been trying to get their caesar for years. They've been putting that, been putting in the paperwork, they've been doing more training assessments. They've been doing everything but they still haven't managed to get it and stuff. Do you want, do you want to continue to have to try and try and try, or do you want to be able to start your training program? Be giving your C C T date? It might move a few times from maternity leave if you're, if you're the inter, if you're the internal registrar, but you've got your C C T date and you know, it's coming. Um So also in a training program, you've got a T P D, you've got someone whose job it is to look after you. You've got someone whose job it is to make sure that you're going to rotate around all of the subspecialties. You need to complete your exams. You've got someone whose job it is to make sure that you're training needs are being met. I think that's invaluable and anyone who's taken a year or two out will notice that the ERCPs as annoying and arduous as they are, they're actually invaluable when it comes to revalidation. I've had quite a few colleagues who get a bit of trouble because they realize they need to sort out all their revalidation themselves. If you've got A R C P it's done, you don't need to think about it. And lastly, if you're training in England, then your study budget is unlimited, you can get, you can do all the courses you need to and they are paid for by the Dean Ary. So I'd say I've probably given you a few incentives to enter traditional surgical poor training pathways. And so I think you need to vote for me. Thank you very much. Lovely for those of us who just joined us. If you could kindly log into mental dot com and just vote so that we know your opinions. Before and after the debate, I'm gonna bring in Goldie to sort of provide the consultant opinion on surgical training pathways. Goldie, please take it away. Yeah, well done ladies. So um interesting views on both sides of the fence. So Kirsty in answer to the concerns that you brought in, you know, having this flexibility, this amazing, you know, local program that you're gonna have created for you with potentially no job stability, no incentive at the end of it for anything to happen apart from you just being a service doctor for years for you actually to be potential in a place where rather than appreciating you rather than having a TPD fighting for you has got no one looking after you apart from you or they're filling in a row two gap of feeling in the night, feeling in a S H O. So the worst case scenario would be to take somebody who is highly motivated wants to be a surgeon is dedicated this and to have somebody stuck in that potential dead end. So that is a risk. So if you are going to be going down that pathway and you have, haven't had the opportunity or you choose not to, then you really need do need to choose where you, you have this. So if you, we, we have an internal rotation, we do that in Brighton, other place to do that as well. So that is critical. You need somebody there in effect your local TPD. If you want to talk about who's going to take you and bespoke Lee, give you something that's going to be relevant for you. That's gonna be allow you to clear all those hurdles because the Caesar isn't an easy route. But to give you the example of a trainee in our, in our hospital who has got through the Caesar route. She has basically done so much, you know, more than it was required of her. So her barrier, she has had to stay locally because of childcare issues, her barriers and her uh her graft when it comes to that has been more than a training would have been at that stage and yet she's done it. But the, the worry would be that if you are in this sort of non training road, non training grade job that you are actually taking advantage of. So if you are in that, then you can vote with your feet. So you have got the power. So it's not about money, it's not about, it's about getting your career, making it bespoke for you. Not moving schlepping in all the regions of, of the southeast or southwest, etcetera, which is the disappearances you will come to in a second. But in treat, you know, if, if you get it right and if you've got, you know, speak to trainees, speak to others in asset, make connections in this area where you want to, to be, do some locum. So that's why I used to do locum all over the country. Get yourself known, talk to, you know, piers and then you will know which other local beacons where they will support you. It isn't, you aren't ignored and that's the key. So what you're describing, done correctly sounds amazing but done, not correctly. Or if somebody doesn't take care of you, then the risk is you're totally left on your own and you are purely service and you'll be ground down in basically just in nights and covering. So be careful but done, right. It's brilliant. So, yeah, but very good points. Lola. So what can I say? So I did all of the above. I'm a sucker for uh you know, applications if you know, it's hard to get into our over there, you know, I'm on the cue to do that. So it's a little bit is belligerents and surgeons are like that. So, if you can, if it's hard to do. Yeah, I'm first allowed to do that to get it. But again, not all programs are the same. So I know that now from, from my time and I said not all regional programs are the same in the same specialty. So what you get offered, uh, you know, the support you getting variety of teaching hospital isn't the same. So your, your chances we heard yesterday of doing an inter dina re transfer if you need to, if there's a family issue or, you know, there's a problem, we've had a row or something's happened is next to impossible. Your options are to leave. All right. So I think the rigidity of that is comforting in a way that it gives you an end date support to etcetera. But if it doesn't go well, then I've had colleagues who have been fantastic. Surgeons have had a row, significant row one issue and I've now had to leave the country purely, you know, gone to Australia. So it is pros and cons with it. So the fact that the barriers for, for a traditional, you know, training program are getting higher. I agree with you whether or not, you know, I have got in or any one of us would have got in is looking more and more unlikely, isn't it? I can't believe the barriers. So I'm on the other side of the fence. So I do the assessments for cool. You know, course surgical training. It's amazing what, what's required, it's off the scale. And I don't know why it's got so high because in our hospital and other hospitals, we've got so many rotor gaps. So why we've got rotacaps at that level and actually we can't fill with the training post. So anyway, that's my point. Lovely. Thank you very much. Round applause will be, please. Thank you. So we're going to open up to yourself. So this is your opportunity to ask the panel members or express your opinions and how you or what you feel about this and keep the votes coming in to have you got any questions from the audience? Got one over there? Okay. Uh Hi, everyone. I'm Laurie. I'm uh I come from this from slightly biased angle um currently on locally employed doctors, CST equivalent programmer imperial. Um And the way they've set it up at the moment is completely equivalent to core training with a T P D. You have an educational supervisor, clinical supervisor, unlimited study budget, unlimited study time. Um And to me, it doesn't seem I'm on rotations with your trainees. It doesn't seem any different in, in that respect and I get to stay Imperial, which I never would have gotten to if I had gone through CST. So to me, it does seem like at least at core training, there isn't an incentive to go into the traditional routes. My point on it would possibly be that maybe rather than there being no incentives, maybe CST as it stands at the moment is not, or traditional surgical training isn't fit for purpose. Um And whether these nontraditional ones are filling in a gap because they are free agents and they can sort of create it as they wish. Whereas the traditional training routes are much larger and have to be much more standardized and therefore it's much more resistant to change and cannot be listening to the people who are doing it um in order to change to be appropriate. Lovely. Thank you very much. Do we have any comments from the panel about that? I mean, I think we've already heard about two, you know, you're set up down in Brighton and, and period that they're doing it well, when I say vote with your feet. Yeah. So there's two places that if anybody's interested this route, apparently that's where you need to go and I'm sure others in the room, no, of places where it is happening. Well, um and I'm just like with all kind of market pressures, other places over wine, I mean, we go rotacaps, we need to fill them so we need to be doing things better. Um And, and so that can only hopefully drive improvement in the more locally employed kind of uh route. See, I'd agree that these, these posts are fantastic and if you manage to get it, then that's, that's amazing. But what happens. If you, you go to the interview Imperial, you don't get the job and then you have to then go and look for another, another equivalent job somewhere else needs interview for that one. You might not get that one as well, then you might, you might end up needing to do five different interviews in five different places before you can find somewhere that you can actually work. And that's where the one interview and you, you don't know where you're going yet. But once you get your job, you know, you're in, if you see what I mean, and then also it's about the standardization. So, you know, that, that, that imperial job is a good job, however, you might get into one, it seems like it's a good job and then you get in and it's actually terrible because they've got no standards that they actually need, they actually required to uphold. And that's why it not CSC particularly not all jobs are fantastic. However, they do maintain that the minimal standards that you need to make sure that you can continue on in your training. And so when you're locally employed, it's just a bit riskier. If you get a good job is fantastic. It's just, if you don't, then you're, you're in trouble. I would agree. So fantastic here about Imperial. I would try before you buy, talk to your colleagues do low comes spread yourself around, see what's, what's available and vote with your feet again. You know, it's, it's your marketplace to, to find a place that suits you. Okay. Have you got any other questions from the audience? Keep them coming the middle of the room. Hi, I'm Susanna. I'm currently working as a clinical education fellow. Um, but it's not really a question. It's one of the comment I think. Um, what I would say is that while probably the out of training posts, you have no guarantee that it's going to be a good place. I think, unfortunately, currently the problem is that with core training especially, you have no guarantee either because, um, the department are work and unfortunately, is really, really bad for core training in a way that, um, the trainees are not getting opportunities that they need to meet their correct, um, to the point where they have to come in on their days off to actually go to theaters and get the cases. So I think the big issue is that nowadays even going into standardized training, sorry, doesn't give you that guarantee and that safety of actually meeting your curriculum and having those opportunities that you need to progress. I think you're very, you're very right. Um, and I think part of this, I think is that core surgical training at the moment is just not doing its job. And I think that's probably what we need to address separate to the, the idea of a traditional training pathway. I think we've kind of, we're just, we're in the, we're in the point where it's, it's not delivering. We've been trying to improve with I S T worked in Scotland, didn't really work in the rest of the country. Um, that's, that's what we need to do. We need to make sure that those jobs are actually doing what they're supposed to do because there are ways that we're supposed to be able to report it. You should be able to speak to your head of school. They should be able to take the trainees out of the unit. If it's not providing what it should be doing, we just need to make sure that the standards that are in place and the processes that in place are actually adhered to. We need to use them to actually improve the training programs that we've got. I would, I would agree. So the one thing I would also say that we haven't talked about yet is don't be afraid or scared of going out of your comfort zone. So staying in Imperial, staying in Brighton is comforting. It's great. It's fine. It's all etcetera. But I always encourage our junior doctors who do that, who have been with us to still maybe try and go somewhere else. Um, you know, maybe we've got contacts, I've got contacts either nationally or internationally for them to do experience something different. So I think, um for your, you know, for your future, you should, I mean, I went to, I had to break out my training pathway um to go to Australia, which I've always wanted to do was advise strongly not to go to Australia because I wouldn't get, uh, you know, I wouldn't be able to come back to the training pathway. And that was totally wrong. So that was the wrong advice. And you're quite vulnerable to who tells you that sort of thing. I would strongly suggest if you can uh from a personal point of view, money point of view, you know, family point of view, if you can, then I would explore going out of your comfort zone somewhere, we don't know abroad or somewhere else in the UK. And that really opens your mind and it makes you a better surgeon and better able to deal with processes. You can bring back so much more than just staying in one place, just learning the Brighton way, obviously fantastic. But I think you come back so much stronger if you've done experienced it rather than just being one bit. Yeah, I absolutely reiterate that point. I, you know, having grown up in Dural Scotland, um the increase in my cultural competence, moving to other regions within the UK has served me incredibly well. And so I would strongly, strongly encourage that whichever route you go down, move around a bit and see how things are done a bit differently. Um So, yeah, no, interesting Lola's point about trainees and having that protection. How many of you actually heard of a unit? That was a bit dicey. Having the trainees removed? I mean, I know of them. I know of a couple but it doesn't happen quickly. Does it, it doesn't happen as quickly as it shoes. Um, it takes a long time. Generally your notice period on a local employed contract is a matter of months, not even. And you can stick some annual leave in there. So there are other protections. I absolutely agree. But the juggernaut that is the Dean Ary takes a long time to get moving. Lovely. Thank you very much. So, what, what I was gonna start doing is I think we're gonna start wrapping it up to you guys, have a minute each to sort of summarize, give you closing statements and this is your last opportunity to convince people to vote for you. So I'm gonna start with Lola. So this house believes that there are, there is no longer incentive to inter traditional surgical training pathways. I've given you lots of incentives to interest traditional surgical training pathways. So, yeah, that's it. Uh I think the word that we've heard a few times today, standardization, that's what training programs give you. And as I look across the stage, but more importantly out into the room, you guys all are clearly the same, exactly the same and have the same needs and all the rest of it and standardized approaches don't, they don't work we're all different, we're all individuals and we all have different needs, whether that is within our professional development or personal development. And I think that it's becoming more and more apparent that the rigidity of traditional training programs are no longer meeting the needs of the incredibly diverse population that we have in surgery. But more importantly, the incredibly diverse population that we want to encourage. Um so that we have more and more of these uh different people as visible role models for my future colleagues. So yes, there are incentives one way the other. But I think that the incentives to not enter surgical training might be becoming a bit more popular. Goldie. Um So parts of both of your um arguments that I've agreed with and do agree with and have personal experience with. But as a, as a consultant, as a, as a trainer, as an educator, I think one size probably doesn't fit all. And I worry about the rigidity of, of a training program system. I think if you've not got a flexible proactive TPD, then you are at risk. But then again, in a local department with a local structure, again, if you don't have somebody who's embedded in that ethos, rather than somebody who's embedded in filling in rotor gaps and filling in nights and filling in ward cover and you know, that sort of thing. So you need, you need the right person at the helm and he or she or them needs to basically look after trainees and look after their junior doctors and without that both systems are at risk. So you are both correct and you're both incorrect. That can be diplomatically. I've seen examples of both systems which have been shocking for trainees who ended up leaving surgery. We've lost them, they left the country, we've lost them, they've stopped, they've totally changed that. You know, it's, it's, it's burnt them out the system and that is horrific. So all we can do as a, as an audience and together on the stage is if we see that, we vote with our feet, we deal with it in the Dean Ary or we deal with it locally and we spread the word and asset is amazing for that. So the platform, this is the only national independent group we've got, it's not affiliated to any colleges. Yeah. So this is the only thing we have. Thank you very much round of applause for all the panelists, please. Thank you. So, the moment that we've been waiting for is the post debate. So it should all pop up on your screen, vote, vote, vote and then we'll see who's one. Exactly. There were 100 and 39 votes last time I expect the same. If not more wondering if I can use this as a way. I think I just start retreating unless it's not go down the season. CCT and the season even more of a registrar last few votes. Jesus. Oh, wonderful. I think I'm gonna call it there. So I think it is emphatically agreed that there are no longer incentives to end of traditional surgical training pathways. Thank you very much guys for your time round. Of course, the panelists.