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Brilliant. So we're live now. So if you want to just go ahead and I'll inform you of the results of the pole after I send it. Good, good evening. Welcome to uh Black Belt Academy of Surgical Skills. Uh I'm joined this evening by Fellow Sense I Tim Terry and I'm Chris Chris Caddy now David er is not with us this evening. Um So this is one of the few times when he's not live on, on the scene but behind the Black Belt Academy of Surgical Skills, which so far has been very much about trying to inculcate into the audience, the need to uh learn skills, to learn technical skills in order to be able to practice surgery. But behind that, there's a mindset which he's also dabbled in and, and that's where Tim and I come into the frame because we see surgical training as much more than just learning technical skills. It's about developing the whole person. So Ria's put there a pool pool and what we'd like you to do is to fill this in and let us know who you are and what level of training you're currently at. So we'll give you uh 30 seconds to do that and then we'll come back and uh and explain what the, the pool's got. So I'm um I'm Chris Kenny. I'm a, I like to say, I'm a rewired uh consultant, plastic reconstructive and aesthetic surgeon. So I've had a, a long journey uh in my surgical career to get to where I am now. And I'm now in the, the return phase of learn earn return. So I'm at a stage in my life where I'm giving back to the surgical profession. Uh and it's been a wonderful journey and, you know, I think both Tim and I are very passionate about what we do, but we're able to reframe the situation because of the journey that we've been on and on that journey, we met lots of people. We've had lots of uh ups and downs. Uh but at the end of it, we're there going. Yes, how does it get any better? And it's about getting you to understand how you get to where we are and it doesn't happen overnight. So, Tim, do you want to just explain a little bit about who you are? Yeah, I've spent 47 years in the NHS, most of them as a surgeon at various levels. I've done over 30 years as a consultant. I started in general surgery, went through various subspecialties but did a final training in urology initially, general urology that moved into reconstructive urology. So I've done lots of different things in my time and seen surgery for many aspects. Towards the end of my training. In the last 10 years, I've been interested in mentoring in trying to help er junior colleagues and also to help leave a legacy when I retired from clinical practice, which is the current state. I am retired now and I spent this afternoon doing uh examining in mock FL CS urology examine this evening. I'm talking to you and my passion is about mentoring and I can get to that with the help of Chris during this talk. And I want to make you interested in mentoring and look at it and perhaps take it up because with it, it will help you survive the adverse events you will come across during your surgical training. So when you go right back to the beginning, when you went to surgery, well, when you went to medical school and then into surgical training, when do you think you were first exposed to mentoring? What did you understand mentoring to be? Ok. In the audience? We, we haven't. So Ria can we have the results of the poll? Are you able to flash that up on the screen? She seems to have abandoned us. But so we, we are both consultants to a certain extent, we are towards the end of our, of our journey. Um But it, it's been a journey. It it's, it's not a goal. So becoming a consultant is not the goal that you need to be. It's it's gonna take you beyond that, apologies for the delay in answering. If you take a look at the right hand side, you should see three icons and there's a chat icon at the top of the right hand side. Uh Yeah, it's got so we click on that, right. Yeah. And then if you're on the drop down bit that says messages, you should be able to see the results of that poll there, right? I so I can see that. So 71% are medical students, there are no foundation trainees, no SHS no registrars and the others are fascinating so that they're also very senior people. So we basically got a medical student audience and a few extras. So I think we're really going to be talking to the medical students and the medical students and the consultants who are watching us as well. But it it's at the beginning of your career, how do you find a mentor? What is a mentor? Because in order for mentoring to work, you need trained mentors, informed mentees and some form of matching system. So we're on our way. So you and I are trained mentors. We're now we're informing the, the mentees. Uh and then it's a question of how we match them up and we can do that through BBS and me. So as, as a medical student, where do you think you came across your first mentor? Do you want me to answer that one? Yeah. OK. Did you, did you recognize him or her or it? II think as a medical student, what you you assume as a mentor is what we call informal mentoring. That is you have someone who will go with you in a journey will help you understand, things will explain and advise, but they do it from their own experience. So they're like friends, family colleagues. These are it's informal mentoring. So it's not from a trained mentor. Specifically, a trained mentor is someone who's taken time out to look at what mentoring is and develop ment mentoring, which is what proper mentoring is, involves having to do quite a lot of work and training in terms of asking the right questions, finding the right mentees and matching them and then going on a journey of what we call becoming. In other words, we set goals and targets and we see how we get on. But to start with mentoring is informal until you have a trainee or mentee who goes along and, and matches with a trained mentor. So it's very important to understand the difference between informal and a very formal mentoring process. So I think that's my first point. Do do you wanna highlight what a patron is and what's the difference between patronage and mentorship? Um Patronage is just I like you, Chris and I'm going to look after you and I've got a set of contacts and I'll introduce you to these people and you can take it from there. So I use my influence and my networking to help you in your journey. Mentoring is nothing like that. Mentoring is someone comes to me and says, I've got some issues and I said, OK, well, what we can do is um you tell me a little bit about yourself and I'll tell you a little bit about myself. And then if you wish to, we can embark on a journey of enquiry, whereby I will ask you questions and I will try to steer you in different perspectives so you can come up with your own bespoke solutions. So, mentoring is not telling or occasionally it is, but it's not telling. It's helping someone through a journey by altering the perspectives. And the mentor has to be very good and not only listening in an attentive way, but being good enough to read between what's being said and what's not being said and to match that towards with body language so that you can see both in terms of what body language is. You can hear what they're saying and you can see that some things are not being said, which do need some exploration and that's where challenging questioning comes in. And those are the skills that you learn as a formal mentor as a developmental mentor. II think the, the the the difference here is, is about what's required in the way of training to become a mentor. Yeah. Um I think a lot of consultant surgeons think that they're already mentors and they do it naturally. Um And, and that is a, it's a limiting assumption um because to do it properly, it, it's not one of these things that you can go on a weekend course and all of a sudden you're a mentor. Um And it, it's something that comes with practice. It's a bit like learning to swim. You, you've gotta dive in and experience the, the water on your hands as you pull through the water and how that affects your body and how you move through the water. You can watch as many youtube videos, you can listen to lectures, you can know it in theory. But until you've actually done it, it means nothing. Yeah. And I think, you know, um just like you can learn a bit of surgery and I can teach a medical student to do some simple surgery. And in fact, when I was 1/4 year medical student, I did my first appendicectomy. I was helped by a registrar. But as 1/4 year medical student, I did an appendicectomy skin to skin. Now I wasn't qualified, but I did the operation as a mentor. You can mentor people without being qualified without being accredited. But my accreditation was quite a lengthy procedure. It was four days at a university. I had to do written assessments. I had to do um practical assessments. And I had to submit films of me doing mentoring. And from that, I got two modules, a master shift level at one of the local universities. And if you do um mentoring for the international learning and mentoring body and you do it to level seven, you have to do at least um six whole days and you have to have a record of 100 ah mentoring episodes which are looked at by someone who see how good you are or not, how good you are. So, that's a pretty powerful way to get accreditation in mentoring. And it takes about a year in all to get an LM seven in. So there's a big difference between learning a few words and talking to people to becoming a fully accredited mentor. And within the mentoring process, there's lots of other things you can put into it. So there's neurolinguistic programming, for example, which teaches you how to read people from body language and the words they say, you know, whether they are kinesthetic, whether they are oral, whether they are um visionary, the words they use, tell you the way they think. And if you can mirror them, you get very closer to them in the conversation. Now, not a lot of people do neurolinguistic programming in mentoring. But if you do it makes you somewhat special. So there's lots of different things that you can learn as a mentor to bring in to asking challenging questions and getting a feel for the person and of course, like everything else you develop experience. So once you see one particular type of problem and you see it several more times, you learn how to deal with it in a much more fluid way. So there's a lot of learning as opposed to just having a, a piece of paper saying you're a mentor. Yeah, I mean a lot. So, so one of the things that David says, you keep doing it until you can't get it wrong, you practice it. Um But in, in mentoring, you have to put yourself into lots of different situations you do in surgery. Yes, every patient is a different operation. Um But you've got an idea of where you're going. But with mentoring, you have to find out who the mentee, who the person is, what makes them tick, what their challenges are and what their limiting assumptions are and you do that primarily by listening to them. That's why we've got two ears and one mouth. So the relationship is, is very much about listening and it, it's how you develop those listening skills. So you wanna see a little bit about how we listen. Yeah, I think um most, most of my colleagues, most surgeons listen to speak as opposed to listen to learn and there's a big difference in that statement. Um And if you look up in the literature, the mean length of time between a consultant um speaking to a patient before they interrupt again. It's 10 seconds now that I'm afraid, wouldn't count for anything in a mentoring session. And one of the reasons why we listen is it because it instills in the mentee, um a little bit of disquiet that they can stop talking and just listen, they have to keep talking, they need to present themselves uh to someone who is very attentive to what they're saying and is not going to interrupt them because by not interrupting them, they are being forced to come out with their story. Uh So that one of the key things, the biggest skill in mentoring is attentive listening. And if you can do that by picking out body language and the type of words they use, we're getting back to neurolinguistic programming. Um You are in a very strong position to read them and mentoring when you're really good, you can read people. Yeah. So, so I'm, I'm biting my tongue because as you were pointing out in most conversations, you're waiting for that gap. So you can jump in and have your say. But a lot of this comes back to Nancy Klein's time to think your thought processes come in waves. And if you give them undivided attention and you appreciate them, then they just open up like a book and they tell them what's going on in their life and in their head and, and you let them keep talking and then when they stop, you say, is there anything else you'd like to talk about and you encourage them to carry on. And then suddenly they realize actually there is something else that they want to do and there are key words as well. So for example, you, you know, you might be talking to me for three m three minutes at which point, rather than ask you a question, what I might do is pick out a word, you say a word and I echo it to you. And that takes you back to what the word you said and you come up with another explanation. So you can use techniques to draw more out of the mentee. So use a word, challenge them with it and get them to explain it in a different way. So the the other thing that as, as a mentor you need to be able to do is to give undivided attention to the mentee. But at the same time, part of your brain needs to be analyzing. What are they actually saying? How does it make me feel? How do they feel? And so particularly for the medical students, you are on a journey of discovery and part of that is learning about evidence based practice. And so most doctors feel that they're very good about evidence based practice. And that's because they're using their neocortex to analyze what's going on. So if you take a cross section through the brain on the outside, you've got the Neocortex, but inside that you've got the limbic brain and below that, you've got the brain stem. So the neocortex is fine for describing what's going on. But what you want to do is to find out what are the emotions and feelings that are driving this. And if I ask you to express your emotions or your feelings, you'll actually find that quite difficult because it's something you feel, it's not something you talk about. And so you then have to explore the words that you might use to explain those feelings. And that's a very powerful way of contact or connecting with people. It is. And in mentoring, um I might be listening very intently and uh they may uh come out with several sentences and then I might just say to them, how do you feel about what you've just said? So he'll go straight for an emotion to what they've just said? It stops them in their tracks and they go, what did I just say? And, and I say, well, what's behind this? How are you feeling at the moment? So, trying to get people's emotions out into a conversation is really, really important. And in mentoring, what you try and do is get people to get in contact with their emotional agility. You try and get them to self analyze their self, self regulate and into and into thoughtful mode and then you slip in and how do you feel about all of that. And it really does stop people in their tracks because they then have to look at it from a different perspective, which is puts you on a winning straight because already you're beginning to change their perception of the problem or the issue they've come to talk to you about and when they bring up an issue and they start to explain it to them, you have to think is this issue really true. Uh What's your limiting assumption here? You challenge them by saying, do you really believe that? What's your evidence behind that? And once again, it's, it's about challenging them and getting to think about the process. Well, um I have a AAA talented partner who's introduced a fewer phrases into my repertoire and one of them is, well, that's very interesting. Why did you say that or how did you feel about that? And it really does stop people in their tracks? Um Why have they said that? And what do they feel about it? And these are things that actually people don't really think about as they're talking, but when you get them to think about it and analyze it, they change tack completely. And then you've got a fresh way forward to look at things in a different light. So mentoring, it's not telling it's developing transitions in thinking and that's what the beauty and the specialty of mentoring is about. It's transitions in thinking from the mentee and I think so transitions is the main is the key word here. So as as medical students transition from one year to the next and as you transition from being a medical student to a foundation trainee, um you need to think about where you're going to get help in doing that. So 11 of the other challenges that I have is that in medicine and health care in general, we, we have not embraced coaching and mentoring because it's felt that if you require coaching and mentoring, there must be something wrong with you, you know, but it, it's, it's, it's your problem. Um And it's a lot of this is the system. So if you were in advertising, marketing, commerce, banking, law engineering, they all have mentorship programs as part of their program. It's seen as developmental and it's something that people want to do belong to and encourage members of their organization to embrace. So a lot of this is how do we change that culture within medicine and surgery in particular? Well, I think in big business and we're talking about coaching, you know, what is business about? It's about productivity. It's about making a buck. If you want to make more bucks, you become more productive and you want to be more productive, you change what you're doing and you change what you're doing by looking at who's doing things for. You can they do things better and if they can you coach them to do that. Now, mentoring is slightly different. Mentoring is just getting people to look at what they're doing in a different way. And they have to have the drive to achieve something and to achieve something means they've got to change something, which means they've got to have a plan to do that. And mentoring allows them to come up with a plan uh between the discussion of the issue, between themselves and the mentor. And if the plan then gets uh on board and uh work is done to achieve uh the first or early goal, it continues on a longer journey which we call becoming until you eventually achieve what you set out to achieve. So I think um slightly different between mentoring and coaching, coaching by and large in business, you don't get invited to do it and you say, ok, I'll do it. You get told to do it because it's part of the business plan for the, for the company in mentoring. So just to go back, coaching is the whole process is driven by the coach. Um in mentoring, their agenda is driven by the mentee and it's set by the mentee and the mentee has to engage because they want to engage. So the mentor is there as a facilitator and help help them with the thinking process. So they can get going about looking at how they can move forward with a change to perhaps a situation which they want to be in rather than, than the one they are currently in. So, if we got a mainly medical student uh group here, um how do we encourage them to go back to the universities and find out what's available to them? I think most, most universities are working towards a buddy system. So that's peer to peer mentorship, um which, which gets them to start getting a flavor for it. But I'm not sure of many universities that have got fully developed mentorship schemes. They will have things like pastoral care. They'll have people who are involved in looking after the students, but that's not really developmental mentoring. Yeah, I think that's right, Chris, the issues with developmental mentoring is you've got to have some trained mentors to train a mentor, as I said earlier on is a process. It takes time, it takes a lot of effort and it actually costs. So I was working as an associate postgraduate dean when I did my mentoring. I think the course cost about 2000 lbs. I did the first six days of the international learning and mentoring. Ah course, I think that cost about 3000 lbs. So it is costly, it takes time and you've got to really want to do it because it takes a lot of time and effort. And once you've done it, you've got to carry on with your enthusiasm to see a number of people a week. So you can keep your skills intact because it's like anything else. If you've got a skill and don't use it, you lose it. So you've got to keep doing it. And if you really want to be good at it, you've got to do more and more and more and you change who you mentor. So for example, it would be very easy for me to mentor medical students. It becomes more difficult when I'm mentoring someone like more, more difficult when I'm mentoring someone like Chris. Because this is a uh someone who has as much experience, if not more experience than myself. So you do need skills to manage the relationship. Yeah, but but it it it's so part of us being here tonight is to talk about mentoring and that's really it's to start disseminating the the thought process. It's about changing the culture, the drive, it's about working more towards values driven rather than the elephant in the room, which is is a lot of this is has been driven by a skills acquisition. But behind that is is setting the mindset to allow you to do that. I think. Yeah, I mean, mentally encouraging if you want to use a very broad term are talk therapies. And in its simplest form as medical students working with other medical students and junior um university or medical staff, it's key to have good connections. That is you introduce yourself to others, you talk to others, you have respect, you have values for them. And you want to encourage a conversation and this allows you to build up a network and from there when you have a particular issue, which you can't solve yourself, you can go to someone and say, look, I've got this particular issue, I've thought and thought about it. And do you know what I just feel stuck? Is there anything I can do about it? And that's an ideal point of entry into a mentoring relationship, as I say, for the difficulty, as Chris has said, there are very few trained mentors at that sort of level, but some of the medical schools do have mentors. Most of the deaneries have mentors, but there aren't many of them and there's lots of people within the deanery. So it's all a question of, can you get hold of one? But the most important thing is to realize it's out there, you can access it. If you don't access it through the university or the deanery, you can access it privately. There are plenty of people that you can get in contact with and do a session to help you with a particular problem. If you have the need. Having said that when I was a medical student, I don't think there was really anything that I got stuck on. It was just a lot of learning and you had to get through it and you got through it and then you started on a different journey. But nevertheless, as you go up the ladder, you get more and more um tough decisions to make difficult choices. And at the end of the day, advancement is all about making different choices and then you have to live with the consequences. Uh And at the end of our lives, we have to look at the consequences and the outcomes of all the choices we've made. And mentoring helps you to make a more sensible choice than perhaps make wiser decisions. It, it helps you think at the end of the day, they your decisions. So the mentor does not make them for you. What he does is he challenges you and to get to think, what are my options here. And sometimes you think of the most ludicrous ideas, you think that's not possible, but actually when you drill down to it, things which you think are completely impossible off the wall are a solution, but you have to see that and go for it. I think that's right. And there are some people like South Chris who have an incredible curiosity and drive and are full of action and they're very good at sorting things out until they can't and then they need a mentor. But others who have less curious and are less driven and less action minded. Perhaps the procrastinators amongst us, I'm a procrastinator, need a bit more help earlier on in the decision. And yet at the end of the day, you do have to make your own mind up, but you can be shown different perspectives. So you've got a choice rather than just be left with. Well, what do I do? I'm going to do that. Yeah. So it, it's a series of choices that you have different perspectives that can be given to you. And then you can look at, well, when you do mentoring, you say, well, if you do this, what are the consequences? What are the risks? And you go through in your own mind, what are the risks? And you go through the various uh things that could go wrong and what you might have to give up. And that's part of the mentoring discussion. So the other thing that I wanted to bring up here is that um is the difference between IQ and EQ because I think most people that got into medical school have demonstrated that they have a relatively high IQ. And by definition, 50% of the population fall below um the, the medium which is a, 100 IQ. Uh And so everybody who's in medical school feels yes, II made it. But that only counts for about 20% of people's success in life. The really important factor is their eq, their emotional quotient, that's the ability to establish rapport with other human beings and work with them, not against them. And, and I think that mentoring I needs high EQ and it helps you to develop that. That's right. And one of the proponents of that. Um, currently is Suzanne Davids wrote a book about five years ago writing a redo called emotional agility. And what do we mean by emotional agility? What we mean is I, do you have a capacity for being self aware? In other words, this is a bit like getting on to mindfulness. Are you aware of what's going on around you? Are you aware of how you think about yourself? Are you in contact with your emotions? Now, most of us don't ask those questions. Whereas people with well-developed emotional ah quotients, do they think in terms of what they're doing, what's happening around them? They have situational awareness. They have a lot of empathy and they do ask themselves to have questions like if I do this, how am I going to feel about it? How is it going to affect other people? Uh So emotional agility is very important and it goes back to something else which is worth thinking about. If I say something to Chris, he's got the option to either say nothing to respond. And if he does respond like that or another way, then if you tell people to do something, there's immediate pushback. Exactly. So emotional agility allows you to stop thinking at the limbic system. You can say hang on a minute limbic system. I am not gonna respond straight away. I'm gonna think about that. And then you know what, I'm gonna choose how I'm gonna respond. Now, that choice delays the time between the stimulus and the reflex and emotionally agile. People can lengthen that time quite markedly and it allows them to choose how they behave. So that's part of being self-aware and a part of apart from self-aware, it helps you develop mindfulness, which has lots of benefits all sorts of times in your career. So, emotional intelligence, emotional agility, very important. It's well worth looking at Suzanne David's Emotional Agility book. Um It was, it gave me a lot of thinking time and has helped me as a person. So I would recommend that book. So I mean, one of the other things about so having gone down the developmental developmental mentoring line, a lot of this, it, it's some of the medical students will be thinking about, you know, how do I develop as a leader or how do I develop as an educator? So what you need to understand as a leader without followers, there can be no leaders. And, and that's one of the challenges within the NHS at the moment is, you know, if I'm telling people what to do, you get this push back. And so you need to have followers who are going to follow you if you're going to be the leader and it's the same with education, you need to understand yourself if you're going to be able to talk to people. And it's, it's about understanding different people's learning styles that way that they interact with you. So most medical education at the moment is very pedagogic where somebody stands up and talks to you about this is how I do it, but we're all adult learners. So it should be an under gogic approach to learning. So you already have some knowledge of it and I need to draw, draw that out of you. So instead of being the sage on the stage, you need to end up being the guide on the side and you need to listen to your audience, find out what the needs are and get them to start talking to you. I think this is really important because part of what I was going to say tonight, we still might come on to it is how um surgical trainees survive their training period and we can talk about medical students as well as um and what they need to do, which they don't do is develop a good connection within the team that they work with and outside of the team. So with managers, outside doctors. So they need to have a very good communication system with the managers because unless they have good communication in which they value one another, ah ah then they start running into a toxic work face which then pushes them with problems in mental health. But we could talk about later. We talk about that. What are your top tips in order to build resilience into the the next generation of medical students? I think from being a medical student, it's interesting at the moment, isn't it? Because there's just been a publication of mental health in medical students and they're not doing very well. Something like about 50% of them are having mental health issues. And the question was asked how many of you envisage being in the NHS, once you've finished your foundation years and the answer was a third of them would not be in the NHS. Now, that's a questionnaire that was sent out to something like about. I can't remember whether it was 10 medical schools or more, but there were quite a few people questioned and the overall response was 30% of them. By the end of foundation year two would not be in doing medicine in this country and may not be doing medicine at all. And it's interesting that before that questionnaire was sent out, there have been questionnaires every year by the General Medical Council for all trainees in all subspecialties um in the UK, and it's called the National Training Report. And when you look at the National Training Report, 44,000 trainees, the number of people with moderate or severe um mental health problems in terms of burnout was about 60% 60% of the workforce at a training level up to fy two are burnt out either moderately or severely. It's not too surprising when you add the factor that they don't feel they're being paid very much that they are going to leave this country and work elsewhere, or at least that's what's being said. So I think that's very interesting. But nevertheless, you look at the most recent poll, I think it's, it was published by the BMA or B MJ series that medical studentss, a third of them would not be doing medicine. After fy two, we've got the result of our poll. So, so for that 50% of them, uh envisions themselves working in the NHS in the future. Um 25% say no and 25% say maybe. But you know, if you, if, if I look at my own journey, um I came out of medical school and I saw the NHS and the emphasis then was on service. It had nothing to do with teaching trainer education. And so I went off to South Africa for 4.5 years. I went to Australia for two years, America for a year and then came back and gave it to the NHS. So everyone has their own journey. Hm. And at the moment, people are trying to be corralled into doing it in one way. Yeah. But one of the things about having a mentor is he'll ask you questions. Well, why are you doing it that way? Yeah. Are there other ways that you can do it? Yeah, absolutely. You thought about doing XY and Z, you know, I mean, going to Antarctica and being an Antarctic doctor was on my list of possibilities. Going to Australia and being a flying doctor was on my list of possibilities. You know, we call, we call this in mentoring. Walking your, why? Why are you doing this? What would you rather be doing? And if you would rather be doing something else, why are you doing this? It's called walking your why? So that's what we have to ask our audience tonight. Why are you doing what you're doing? Why are you here tonight? Nothing on telly. Yeah. No, there's too much on the telly at the moment. I think um I think the, the issue, uh some of the issues at the present time is um the medical education, certainly for fy ones and twos is too, there's too much of a structure to it and it's very hard work and on top of doing the job, they've got a very heavy portfolio that they have to keep going. And, and if you don't like this, it, it's doing a job not doing something you really enjoy. It's like being in prison and people are feeling a lot. The, the, the, the, the work area in the working environment is very toxic and very dysfunctional. There's too much to do, not enough time to do it. The intensity of the work is very high and the resources are low. They're working in an environment where no one is really listening to them. No one is supporting them they are being asked to do extra work, they don't have any control over there. Their timetable, they're not really being taught, they're just being used for surface and so on and so on and so on. And when you look at the original definition of burnout, which was by Herbert Luden Burger in 1974 he was an American psychiatrist, psychologist who looked at nurses in a free hospital in America. And he noted that these people who were looking after the patients got burnt out. And it was a question of not only the environment, but also there was an element of personalities and certainly in resilience, part of resilience is due to personality traits. Most surgeons are perfectionists. 80% of them are perfectionists and of those 60% have imposter syndrome. So before you start getting involved, yeah, I know you're so whisky before you actually nobody else can do it as well before you get into the toxic environment, you always set yourself up to fail if you're a surgeon because you're a perfectionist and 60% of you got an imposter syndrome as well. Most of you will have a degree of narcissism that doesn't help and some of you will be introverts and that doesn't help either. So personality traits added to an environment where there are very many factors and most of them are negative, um is where your resilience drains away. So that ultimately you feel less able to give less able to empathize, not particularly keen, more on developing your CV. And you're burnt out. And this last year, 60% of trainees across the board of all subspecialties were burnt out using the Copenhagen burnout inventory based on seven work based questions. Now, that's got really serious consequences because when people finish their fy two, they say hang on a minute, I'm not going to go through to run through. I'm burnt out. I'm, I'm knackered. I wanna break. I wanna do something different. I don't want to be forced into another six or seven years being told what to do and how hard to work and work, work, work, work, work. I want a bit of time to myself, develop my other interests, go to the attic and, and all sorts of things and they're saying enough's enough and, and not only are they taking what's called an F three, which is supposed to be one year, but actually as indeterminate it can be as long as you like, um, to a certain extent and they're going abroad as well because they get better pay and they have a different experience. Now, half of them at least will come back into the NHS. And many of them will have trained abroad before they come back. But that's by the, by this is not the way the system was meant to work. And the system has been produced really, um through madness. It was based on modernizing medical careers in 2005, which was, that was about shortening it. Three, we will shorten things. But actually all that happened was you, instead of working over a day, you worked eight hours, but in those eight hours, you were running full, full speed all the time. Whereas if you work the day you could, you could have a dinner, you could sit down with your mates. You had a team, you don't have that with the new system. So, modernizing medical careers has caused all of this hassle. Plus government haven't been interested in investing in the healthcare system, but there we are, um, burnout or mental health issues are commonplace. They make you anxious, depressed, you get posttraumatic uh symptoms, uh you can get into addiction, alcohol or drugs. And when you look at um, burnout in consultant colleagues, there was a uh an interesting article, um 2016 of urologists in the UK. Um 15% of them were addicted to alcohol or drugs and 8% of them had professional help with their burnout. That's a huge number of people running into big problems. So, um the environment we work, that's just the surface of it. There's a Yeah. Yeah. Yeah. Absolutely. It's not declared. Yeah. No, I II think everyone, if we're being honest, um, burn out is not a question of, if it's a question of when because people have varying levels and most of us have a, a burn out if you like, which is not too bad and we can cope and we, and we can protect ourselves. We back off a little bit. We perhaps work less hard. We don't work as much. We lighten up a bit. We get into you looking at taking rest, taking exercise, sleeping better, diet. All of those things, learn a bit of mindfulness so we can protect ourselves. But nevertheless, you're working in an environment which is quite tough. And sooner or later, you've got to realize you've got to look after yourself because no one else will. Well, thank you for that. Well, no, but this is about getting people to stop and think it is. Where are they now? And it's about asking yourself questions. And I said, if you can find a mentor, the mentor is there to ask you those questions if you don't ask them yourself. Um So I think that medicine and surgery has moved on and there are some trained mentors out there. Uh Once again, when you get into the hospital environment, there are actually far more trained anesthetists as mentors than there are surgeons. So, Tim and I are, are, we're a bit like unicorns. We're fairly unique in this role. Um But we've linked up with David to look at how do we take the next generation forwards and help them build these uh this resilience into their, their life work balance. So you take the person into your workplace and you often take the workplace home with you. So it's not about having a personal and professional balance. It's about getting your life work balance sorted. I would call it harmony. I don't like the word balance. I like the word harmony because you've got to have a harmonious life. It's when it becomes disharmonious, the crap really happens and it has the potential to happen to all of us. And you mentioned a and I don't mind telling you that when I've done my research for publication on mental health, anesthetists and vascular surgeons are top of the list in terms of getting burnt out. And there are more suicide deaths amongst anesthetists than there are surgeons so that they have ready access to the blood. Well, that's, that's one. But also I think they're constantly up against the pressure that you and I are operating below the neck aren't really. So I think, you know, they can, they're in a situation where something can go wrong on the simplest operation because it's to do with making sure the airway is ok. Cardiovascular system is ok. And now patients are coming through the door and they've not been properly assessed and they've been put on a list and they haven't had time to assess them and then a crash happens. So anesthetists really are up against it at the moment. II, II, think the key is um, you have to look after yourself. Uh, you need to set firm boundaries, er, sleep, diet, exercise, control, alcohol intake, keeping a journal is very important. But, and I do this at the end of every day I ask myself what went well, what didn't go so well, how might I have done things differently? And my final question to myself is how do I feel about that? Uh, and if there are issues, I make a note in the journal and I then, uh, do a bit of reflection which might last a day or two and see whether I need to make changes or not. And apart from that mindfulness, I think works for everyone. I think taking micro breaks during the day is very important, but it's very difficult to do. You must take the macro breaks, which is your annual leave. But micro breaks I think are helpful. It's really, really important for the harmony that you realize that work earns you a salary and drives your values to a certain extent. But your home life drives the rest of the values in your life. And if you don't manage when you're not at home in a very structured way and wholehearted way, it's very easy to lose that part of your life. And 40% of families among surgeons go south. Um, and that's quite easy to understand. I think it's really important to preserve time with family, friends, relatives. And I think it's really important to be able to talk to anybody. Um, when you need to so have a few friends who understand how you feel and you don't mind lightning your heart and load with them from time to time. Sage words. Thank you. Thank you, Tim. Oh, so, so, so when I've got problems I can unbundle with, with you, you can, you can his wife who's even better than Tim is if that's possible. My, my wife is outstanding and, you know, I II do my very best to live up to her standards, but I'm desperately sure, but I do learn new words and uh new comments each day. Well, I've thoroughly enjoyed this evening. I've got a lot out of it. Um I hope the audience will go through the what? So what and now what, so this is about reflection. It's what have you learned tonight? So what and what are you gonna do moving forward? So this is all about building a resilience program which will take you forwards. Um Any last minute questions, Ria. So we, we've seen the outcome of, of the mentors who 60% 66% haven't uh been mentored. 33% have. But once again, I would really question, has it been through developmental mentorship or just somebody that's taking you under their wing cos there is a difference. Um And, and that's what I'm trying to get surgeons to understand what I would say as I'm retired and I quite like leaving a legacy and bringing the younger people on if people want to drop me a line and spend a little bit of time talking to me about issues. I don't mind that at all. Very happy to do that if that will help them. So by all means, drop me a line if you wish and I'll see if I can help you. So the, the these are what are called chemistry sessions. So, you know, in order to find out what's going on in your life, we need to listen to you uh find out what's going on. I think the Black Belt Academy of, of surgical skills will be about developing the sensei into becoming developmental mentors. So once again, they can be accessed, but it, it's a very steep learning curve and it doesn't happen overnight. So it, it's there on offer and we want to make it happen great. So as they say, thank you very much, na uh and we'll stop there. Thank you. Ok, Chris. So Ria, are you gonna switch us off? So we're still alive? Oh, there she is. Hi, Rhea. Yes, no problem. I will. Are you gonna, are you gonna terminate the uh the evening?