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A question that still needs to be answered. So can you drill down a little bit more into the difference between education and training? Well, I I said, as I said previously, it's education for me, it's a foreign process uh that maybe um determined by some regulations that mm speaking about medicine, I think it's pretty uniform, at least for the formal uh part of medicine. And uh we also may talk about how educated some and in terms of uh goes beyond the knowledge uh that also includes character, attitude and all this stuff. But uh if, if we uh ask people how to uh what they understand, if we uh for education, I think that the general, generally speaking that this is uh the general concept that someone goes to school, goes to the union and then has some uh knowledge acquired. But I think we can go deeper in that. And uh because we asked, we also through this process, we may create characters who may create attitudes. And uh I think this is the most important thing that also is the thing that's difficultly has some difficult to shape it. Is there anything else you want to say. So you've been talking a little bit about occasion. But what's the difference between education and training? Training for me, you know, training has different aspects and uh training means that you undertake a specific program in order to see specific objectives to be uh able to perform some procedures, either in a surgery or in other fields. And uh I think you're starting to, to see there is a difference between education and Jane. So training is all about skills development. It's all, it's also skills development and safe and courage because it's not only uh it's how you react to because it's not only to learn how to perform a procedure, but you also must learn during your training, how to uh how to face uh problems that may come up during uh during a specific procedure. It's not the, the uh it's not only the procedure uh that must be uh performed perfectly, but you may also be able to uh face problems may come up. And I think this is something difficult to teach and uh not all trainers have this capacity to transmit this capacity. We can uh we can um teach skills, but it's difficult to uh teach how people can react in difficult situations and uh maybe can be teachable. And we have learned a lot from uh previous uh interviews of people from uh airline industry and pilots. And uh how can we, how can we implement all these uh all these pieces of information. Uh I think it's the most important thing, how can um introduce them, apply them in our everyday life. And we don't have to do uh to wait for some to enter the training uh stages. But we can also introduce from the very early start when someone uh starts school when Stamaril starts at the uni and uh I think this is the most important uh fact that it's not only acquiring knowledge by starting on the books or having some formal training, it's also how you react to situations to adversaries and how you behave with people, how you behave under stress. And uh I think we we have we are still far away from that should be an ideal training. We've got a couple of other people, Ashok and Ashish. Do you want to turn on your cameras and your microphones and join us in the in the main stage? So what we're trying to do is to engage with people this evening, get them to to join in the conversation rather than sitting on the side as a passive imbibe. Er So David's been spending a lot of time and energy trying to demonstrate skills which people are then expected to go away and practice with. But what we want to do is actually engage with the audience and get you to to listen to what's being said. Um So John, you were talking about um we're in, we're in lifelong learning. So that's all about development. It's a lifelong development. Uh And so every day is a learning day. So, Charlie is, you're in Italy at the moment, is that correct? Yeah. So, where does education come from in Latin? So, you mean the etymology? Yeah. What, where do we derive educ ari? What does educ ari mean? Well, I, I think, uh, I don't want to wear on giving this definition but I think Edgar is shaving trust, meeting information, shaping characters. I think this is the bottom line of uh what the education needs to me. But I think I can look up for the, what the exact term. But uh I think this is the most important thing, shaping characters that also includes transmitting knowledge. Ashok. Can I bring you in here? Have you got any observations on education and training? I always believed it to me. Uh the teacher student relationship and you're quite close and went for the training. You have to stand opposite the surgeon, your training and, and only take home and things so horribly wrong and let them try and sort their problems on. I'm sorry, I'm in terrible throat for my medication. Not a problem. It's lovely having you on board and listening to you. Well, we're learning at the seats of masters. So, thank you, Charlotte. Coming back to you, I think. Um so education is from edge a car or do cost to lead out. So you actually have the knowledge in you, you just don't know it. And so a lot of, a lot of education starts very basic. It's about knowledge. Uh and then the training is where the skills come in. So you can train somebody to do something, but you don't need to need that knowledge. So it's all part of your continuing development. What, what we're trying to do here is to engage with the audience and get them to find out what they know and possibly what they don't know. But it's about stimulating your curiosity. I learned my, my surgical skills and surgery. Uh by spending a lot of time with my teachers. It's a different type of education to what we have in England. I trained in India and, and unless we knew what we were in the operation and then read up a magnet study that seem the patient and examine the patient. We weren't allowed to assist in theater. You couldn't just walk in the theater and can assist for a case. Uh huh. And I learned my colleagues reading on cadavers. You can't do it in England, I guess. And with practice, practice repetition and the teacher correcting you at every stage, but he was there watching you and there's a knee born of friendship. It's almost like a father son relationship. So embalming knowledge was easy. What else can I say? I think the Mr As six, comment on continuing practicing, practicing and uh correcting the errors. I think it's the most important thing in training because practicing without having, having salmon supervising and recognizing your errors, you can, you can only perpetuate your errors and continuous feedback I think is from experts. Uh I think it's the most important thing and it's like athletes do and uh every training process requires a continued feedback. Otherwise there is not any development. You continue uh making the same mistakes and I think this is something sad, unfortunately happens and we can see it every day. Uh, everyday experience, not only medicine, obviously, because you need an expert really to point out where you're going wrong and what you're doing wrong and how to correct it. I think most young sons believe they know it all and they're doing it right. First time when you, when you got to be taught how to do it and you have to have your mistakes pointed out and the mystics human points out in such a way that you don't humiliate your training. Mhm. It takes a lot of kindness and gentleness and patience. I remember my teacher when I did my first thoracotomy, he stood there and run the thing. You snapping on my, gently, on my hand was doing something wrong and we did close micro about, um, it's in those days and I still remember him telling us how gently then going to be, how are you going to put it in, in the heart is meeting on the time. But he made me i assistant of, I think continuously from the 1st 15 cases. And then he let me do one. But he's still there all the time in the next 30 years. Double what he took me through and he made sure and went well. And gentlemen, he taught me thoracic surgery as well. And in those days, thoracic surgery was done for tuberculosis and lung absences. Uh and the patient and the face down position, face down, hand down to drain the past that was coming out. So he learned to our prints with a mac when your anatomy had to me perfect. And we were taught to anatomy and we didn't know your anatomy. You were sent out, you living in textbook and made to arenas and come back. Teaching was good. Is it like that today? I'm not so sure. So, John, what, what are your observations on the difference between education and training? Um I think I've been thinking about this, you know, if you take it back to two things, let uh two things that we most of it. Well, one thing we most of us would do is to drive a car, we have to pass a test to drive the car. But the fundamentals of that are in the highway code, which is a written document which you should read and you should learn the rules. If you don't learn the rules, then you're not able to carry out the functions. Now the highway code is in that respect, educational. It's, it's giving you a framework in which to work when you're, when you're going along the road. Um Similarly, if you're a pilot, yeah, one of the things when you start, you know, you have to do ground store. In other words, you have to learn the rules. Uh uh there are multiple listen to your rules to require this. But anyway, that's not any of that. Um, yes, um, education I think is, is learning the fundamental, um, things whereas training is an index thing in, in, in, in other words, um, once you get behind the wheel of a car, for instance, you, you have to start to learn how to steer, how to change here, how to, uh, well, unless you live in the United States with all got automatic. Um, but the other thing that happens once you passed your driving test, think. Oh, great. I passed my driving test. So I'm okay. Well, that's not the case. You're not okay because you develop habits, you develop, you develop something called muscle memory. Um, it's sort of automation as it were in what you do it when you're driving along the road. Um, people don't, don't notice road signs and things like that. I've sat in cars with people and said to them, the driver, well, what was the last road sign we passed and got a clue. So, they're not, they're not, they're not paying attention. So uh as I say, training uh is developing your skills, your practical skills, shall I say? Um that's, that's about all I can I can say on it. So, Charlotte, can you see how John has sort of reframed his life? So at the moment he's at stage where he's trying, he's training to be an observer watching people sitting the advanced driver's test. So he's had to deconstruct what went before it. He's looked at first of all, they need to learn what's in the highway code. And then the next bit is experiential learning. It's a, it's about diving there and feeling the effect of water on you. So when you pull through the water, it has an effect on your body and it makes you move through it. But that's something that you can only experience by actually getting in there and doing it. Uh And that's one of the problems that we have in medicine and surgery is, is a lot of what we try to teach people is something which you use the brain, you use the Neocortex to analyze and work out what's happening. But a lot of this stuff is performed at Olympic level. It's more emotional, it's more gut feeling and you need to get in touch with your gut in order to experience that. And what John's saying is that a lot of it is by repetition and it's about noticing things. So it's not just the technical skills. It's the nontechnical skills as well. It's situational awareness. What was that sign? It's about decision making. We're going to turn left here. What do we need to do for that? I need to slow down. It's about setting yourself up for success. So he's taking a completely different aspect. Uh, and then saying, well, this is the difference between education and training and using that as a, as a role model to teach you. Yeah, exactly. Completely agree. And uh I find more difficult in my experience. It now is uh time from the trainers, all the mentors to dedicate, to teach uh to the uh trainees to their seventies. Because the most important issue, I think it's time available because when some of the trainers are overwhelmed by everyday uh duties and uh issues, I think it's hard to find time to dedicate it to develop skills, to develop uh profound uh critical thinking, uh situation awareness and all these things. So I think it's uh to some extent, I think most of the process of training is uh something unfortunately a formal process, but we need to do definitely you need to do more on that because if you do not reserve time for the trainers, then you will not never succeeded in uh all the uh this we're talking about it will remain just theory because you need to go deeper in this. And uh and there must be uh even process uh training training must be, uh, the same, either either you are in, in Italy or in the UK or an in Greece side. I mean, we, we have, at least you have to have, need to have the same exposure on the, at the end of the training. I think we have to learn a lot from airline industry because I don't think pilots go to, uh, pilots are out pilot, uh, just with a very little exposure. And um I think we, we have to go deeper on that and reflect on that because uh education and trying to go hand in hand, but we have to make a process of uh auditing and uh take a look at all the training schools for specialties. And uh and ask, are we really reaching the objectives that you're supposed to reach? I think this is my uh point here. So, so why have you gone to Italy to do your training? No, I, I actually came here for study, studying medicine and this and then stayed here in Italy. But this gave me also the possibility to uh to see a different reality from Greece and uh also have uh some friends uh that went elsewhere and had the ability and uh to confront with them in these aspects. And I'm really interesting in uh seeing all these differences around the world for something that should be pretty uniform. And uh even in uh the process, at least the formal part then we can talk about nuances about all details, some common, some someone can develop during the training. I think they, you have to be a bit flexible and you have to appreciate reality. So in the UK, uh the GMC National Training uh survey for 2022 said that 40% of trainers couldn't use that training time because they were too busy elsewhere. So they were not available. And in 2015, the Royal College of Surgeons brought forward uh improving surgical training where they were going to give 60% of the trainees time would be dedicated training. Um, but that's all fallen through and they just can't do it. So, one of the things you could adapt would be using other techniques, blended learning. So simulation training videos, um, you can do that to the cow comes home. You can get very good at knowing the sequence of what it looks like. But handling the instruments is another matter. But at the end of the day, you're only going to get your certificate of completion of surgical training. If you're competent, not competent, you won't get it. Yeah, exactly. Uh, I think, uh, this may completely sense to me and, uh, Mr David, uh, just wrote down need to professionalize the trainer and, uh, maybe this is a reality that you a but unfortunately, this is not a reality in other parts of the world. And uh, patient's must have, uh, access to the same quality of training. And uh this is a very important issue because uh surgeons must have basic uh training of the same quality, whatever they background of education, of country of uh they, they have the training and because uh disease is the same and uh we have to standardize the treatment and we cannot uh keep talking about mortality and morbidity. If you cannot standardize the basic treatment, then we can talk about nonsense details. Uh all the facilities or services the hospital may have, but we must standardize and professionalize uh the trainers and give them time. And yes, I completely agree that uh we can create platforms, we can train a lot on ourselves at home. Mr David uh has been uh bringing this for uh for years now in trying to this day surgical schemes at home, how to home the surgical skills. But we still miss uh an important part here that we need to have feedback. Because if I um uh as I said, priestly, if nobody checks me on my skills, then I will keep doing the same error. And I think uh but uh in the technology comes in hand with uh interactive sessions with sending an exciting photos in the videos. I think this may help uh uh overcoming this uh this gap and uh we cannot pretend to have infant time to train uh during our training uh process. We have definitely tried to do a lot on our own at home elsewhere with what we have and, and uh we don't have uh always the uh facilities we would like to have. And this is another important issue. But uh because we may standardize uh simulation as well and with, uh, and I think what Mr uh David has already been doing, I think it's very important, we have to encourage and expand it, uh give the possibility uh to apprehend these possibility also from students, from trainers, from other countries. Um A basically, I believe the trainer should have the training as a shadow and training spends every day in the theater in the same trainer and the trainer is going to make sure that the training is better than him. Many finishes his time with him. I mean, you can have as many repetitions in one practice at home along the rest. When there's that I'm going to create a concern and, and portray numb omissions. To me, a trainer, you should have a trainee, then he dedicates to teaching and training him and make him at least as good as he is. You need to be able to stand on the shoulders of giants and see further. Yes. So every day is a training day. Yeah. And we need to realize that no training today, know surgeons tomorrow, but you know, Charlotte, it's about how do you change the environment in which you're training? What one thing could you do to make a difference. Make sure that you have your training with you for at least a year. Uh, not one day in a week. He follows you. He comes to outpatients with you. He look and goes through the patient with you and read something, read some of the surgery discusses within put it with you before he goes in and he's with you all the time. And the trainers say they're too busy doing other things. The trainees want to go about five account. You cannot get good signs like that. I'm the name. I mean, Tim, is there anything you want to come in and say there it's a mixture of old and new, isn't it? Really? You and I trained at the time when we didn't go home and we did the three day weekend and all of that and that's all gone. So we can't go back to that. I think it boils down to. There are only so many training opportunities. Uh and you just have to access them and you get the level of competence at particular procedure which you can then go off and, and do on your own. But you know, we've changed from surgeons who do everything or did everything to surgeons who are much more subspecialized. So we don't have cancer surgeons. Um For no good reason, we have cancer surgeons because they are very good at what they do. And in the old days, the generalists would do them and didn't get as good results. And I think that's what we're talking about. So we're talking about who's operating on who and do they have the competence and to a certain extent that depends on uh facilities and make some of the facilities are not there at this point in time to train everybody to a certain standard. And that's, that's rather worrying. I mean, it's also about um looking at a particular healthcare environment and deciding what's fit for purpose and how do you support that? So, you know, my, my training was in South Africa, Australia, United States then back in the UK, but I've looked at training across Europe and in the far east. Uh and so what we mustn't do is to impose our way of doing things and what's happening in the far east or India or Nepal or Pakistan. It's about co developing with them to say what are your health needs and what's going to be right to be delivered in your population. Agreed. And at the end of uh you can only produce standards which are in alignment with the resources of the trainer and training. That's all you can do. But Charlotte, it's for you. I mean, so I have certain biases and I'm afraid Italy does not rank highly with regard to um it's medical education system. So you've got far more medical students than you have facilities to teach. So it makes you as an individual struggle unless you actually go out and find the resources that you need. Uh the raise the level. Uh There is a way to achieve some kind of training. But unfortunately, with respect to people that actually uh access to training program, not all of them that seems to be uh to become surgeons. I mean, uh independent performing surgeons. So they keep going. Uh This is something that happens uh everywhere the this is you have to uh learn from other realities as well to go abroad obviously. But I think one if you want to change uh the reality, not in Italy, but everywhere we need to uh when, when, when a training school training program um uh starts accepting some trainees, we need to check if there are some quality standards of training achieved or not. And I think it's a good point to start there and then we cannot all the rest of the things because it's not uh from my point of view, I think it's something unacceptable nowadays that cardiac surgery program has not a simulation uh center uh in the facility are talking about tertiary hospitals, uh levels of hospital to invest a lot of money. We have different departments and uh we are training about, we're talking about uh surgeries of that have uh high impact and uh both in terms of uh morbidity and mortality and in terms of course, so I don't think it's it causes low investment simulation where trainers and trainees can dedicate time spend there because it nowadays, it's even harder to learn specific techniques because we especially in the minimal, minimal invasive area, it's not longer acceptable to crack the chest open in order to learn uh to teach a procedure to a trainer. So can can how can we overcome this problem without having simulation uh perform the same center. It's not only youtube, it's all obviously camps in, in hand, all these technology nowadays, it's easier, but we also have new difficulties that we have to accept then we have to face. Otherwise we will stall in the same level and only some of the trainers access to training from, we will achieve to have a uh a training process will bring them eventually to become competent surgeons. Yeah. So Charlotte, do you have a robot in your training facility? You mean we have, we have revolted here. So, for, for thoracic surgery or cardiothoracic surgery? Yeah, we have general center, thoracic surgery and uh cardiff surgery. And uh we don't have facilities. Uh we have a simulation center here. But uh when, when I, I talked about uh simulation center was uh uh even uh low fidelity models. I think uh we can have it without spending a lot of money. But still, there's not a, it's not uh they're not mandatory training in training for, I don't know what that's the reality in. Uh it's only, it depends, uh it's up on uh, the single trainer if wants to organize a teaching uh process with outside the formal training problem. But it should not up on the single train. I think it should be more of a uh a formal training simulation special nowadays. Well, a lot of that is about creating a culture for training within your organization and that means that has to be valued. Uh and it's about sort of valuing people when they go to work. Yeah. Well, they've just opened a robotic simulation center in Newcastle and people are signed up over about a three month period to do 50 the rightful procedures. So that, that finished. So that's out with the ordinary. Uh Yeah. And, but a lot of that is about, first of all immersing them in the theory so that they learn the knowledge and then it's about gradually exposing them to the robot and there's lots of work which they can do in the simulator to build up their competencies before they then let loose on the human. Yeah. Um And, and to be fair intuitive have got a very good training program. The problem is that that most trainees now want an instant's result, they want to be able to do it um without putting in the time and effort. So it's um as I say, it's, it's interesting to observe it. Um But one of the things that I think trainees need is mentorship and help in designing a program is fit for them and fit for the patient's and fit for the places they're going to work in. So they've got lots of unknown unknowns, which they need to be helped with to discover and you do that by finding a mentor uh and working with him. So the mentor won't tell you what to do. What he'll do is get you to come up with the answers for you. So I don't think Ashley's going to find a mentor nor is John, but Charlie's and Gabrielle, it's all about you going out there and finding somebody approaching them and discussing with them what it is to become a mentor. I think what Tim and I realize is in order to do this properly, you need to be a trained mentor. Uh This is not just patronage, it's not just taking you under your wing. It's about having the skills to challenge you. It's not about having cozy chats. It's about making you really do the hard thinking about what you're going to do, how you're going to tackle it. It's about reframing your life at every step of the way. Yeah, exactly. And uh one final comment, I would like to uh site a quarter of using both the famous out of this. He once said that uh it took me years for a nine second uh race. So time indefinitely is of the essence and uh we need to have patient's here and train a lot obviously because results do not come obviously instantly. And uh uh we may have failures. We and we have to learn from our failures from our, from our eros. But we also need uh desperately feedback how to correct our errors in, in a, in a way that we and we don't have to stumble on the same stone. We have to learn from experts. This is another important thing, especially nowadays, we have access to knowledge. We have internet to have a lot of the ways do not stumble in the same stone. You know, Tony Jacklin used to say, you know that the harder I practice the luckier I get. Um So I'm, I'm afraid our time is now up. Thank you all of you for joining us. As I said, this was a bit of an experiment. Um I've certainly learned a lot from it. I'm sure Tim and Gabrielle has a as well and we need to think about what we do next to engage with more people. Um There will be a uh some feedback forms for you to fill in. So would be grateful if you could do that, access it, fill them in and let us know what your thoughts are. So, thank you all. Um Gabrielle in particular for doing all the work behind the scenes. Tim, welcome onboard. Great to have you long last Ashok as always in the background, stimulating everyone and John congratulations on continuing learning every day. You're an inspiration to us all So until next week, which uh so we've got the Vice President's of the Edinburgh College learning how to assist with David back up in Harrogate. So, thank you. Good night. Thank you. Bye bye.