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Summary

This on-demand teaching session is relevant to medical professionals and will explore the philosophy and importance of respect, humility and reflection in a surgical setting. It is led by David Regan, a cardiac surgeon, and draws on his experience in medical school, martial arts training, clinical and surgical practice. It will look at the importance of note taking and nutrition, hydration and sleep in maintaining sharp surgical skills. By observing stories and anecdotes, attendees will gain a fresh perspective on the etiquette of surgical practice and the need to remain diligent, uncluttered and sensible.

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Description

There is more to surgery than motor skills. Mindset, preparation, and clarity of thinking are of paramount importance. Again, sport coaches will get players to visualise the movement. True champions transcend the noise and bring focus to tasks even when under pressure.

These simple principles have been employed in the instruction of the martial arts for thousands of years. The power and flow are achieved with an attention to the practice of the deconstructed movements with stillness of the mind. Surgery has a lot to learn from these disciplines.

The first thing to attend to is correctness of thinking, communicating, and doing. BBASS aims to attend to all these things to better surgeons of today and tomorrow for the benefit of our patients.

Learning objectives

Learning objectives:

  1. Understand the importance of respect in the practice of medicine and learn ways to show respect to patients, instruments, colleagues, and the environment.
  2. Demonstrate an ability to accurately document patient information and diagnoses.
  3. Recognize the importance of staying alert in practice, focusing on nutrition, hydration, and rest.
  4. Practice mindful and purposeful medical and surgical techniques.
  5. Demonstrate sound analytical skills in order to diagnose and treat patients.
Generated by MedBot

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Computer generated transcript

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The following transcript was generated automatically from the content and has not been checked or corrected manually.

Hello. Good evening. Good day. Good morning. Wherever you are in the world and Happy New Year. And welcome to 2023. Thank you for joining the Black about Academy of Surgical Skills. My name is David Regan. I'm a cardiac surgeon in Yorkshire, in the United Kingdom, the past director of the Faculty of Surgical Trainers for the Royal College Assistance of Edinburgh and a visiting professor at Imperial College London. And, yes, I am third done in karate and second and in Idaho. Thank you to the 3293 followers on Facebook and the 522 followers on Instagram. We have had the pleasure of publishing a video with a song describing the nuances of the one handed surgical. Not and I'd like to thank my fellow Sensei Gustaf Oh, Orelon Oh, in Ecuador for putting this together and John Reilly and Steve for their music and the vocals I hope you find it fun and I hope it goes some way to demystifying the art of no time. I wanted to start the year by explaining the Black Belt Academy philosophy and that is prompted as you will see by my own experience in martial arts. The ritual and respect when coming onto the mat and bound to the sword is all part of the terrorism and Buddhism that goes with martial arts. The bowing is particular. The sword is placed in front of you such that the handle or suba can be reached by the right hand or is mindful that somebody needs to attack when buying to the sword. The left hand goes down first. The right hand is always at the ready. The right comes to the left, forming a triangle of life, and you bow but maintain the view of the person opposite. The left hand comes up and then the right hand comes up for doing that. The sword is then taken and put in about, and the thumb is held over the Suba and it's the flexes pulses longest that actually prevents the sword being taken out and used against yourself. And that is, stops people snatching it and taking it from you. I started martial arts nine years ago when I took my son to the local academy at the age of four and use that in the corner screaming and crying, much to my embarrassment, but took him weekly on Saturdays, too. The lessons and this is a family academy and they're regularly cajoled. Be to join saying Go on, go on, go on. I had looked at the belts that were along the wall and thought, Well, there's no way that I was going to get passed Green belt or blue belt but in the end capitulated and joined. What was refreshing is having spent so many years as a consultant and a surgeon to step back into dojo as a student and learn and then beginning to realize how to learn and what to learn. And the simple respect shown in the deja vu to your fellow annual census is a respect that, sadly, I do not see in surgery. And it's something that we need to re inculcate in the mindset, but only the respect to the Sensei and to your colleagues who are training but respect to the discipline and to the mindset and to the sword and to your religions. The sword itself carries the spirit because of the time it is taking to make the Catanha, and in doing so reminded me there's a respect that need we need to exhibit to our instruments and the respect we need to have for the environment. This goes a long way in Japanese culture, as you will have seen in the World Cup football. The Japanese supporters tidied up the stand when they were finished, as did the Japanese team clean the dressing room. This respect for others, for property, for nature, your environment and the community in general, I think, is extremely laudable and a wholly support. My journey in surgery started in 1985 when I qualified from Southampton. As a student I was doing Appendicectomy is under the jurisdiction of the senior registrar and my grandmother would tell you that I had always wanted to be a surgeon. It was my passions and the Japanese term is icky guy. The reason why I wake up every morning the reason that I enjoy learning, serving patient's and it's a good way to make some money. But more importantly, I feel one is adding value and it delivering a service, particularly with teaching, and that is more rewarding than anything. Once I quantified, I became a houseman in a professorial unit and My first major lesson was that of note keeping to accurately write down what we saw and examined. A patient came in complaining of a painful blue leg, and the patient was otherwise dismissed by most of the other doctors as somebody who is complaining because the symptoms were fleeting. But I had written down in the note that this lady had phlegm Azia Cyril A. Dolan's and despite her being seen for two days by senior doctors who didn't write in the nights, her symptoms persisted and they did not order an investigation. Learn. Behold. On the Monday morning she had a venogram, which did show an Alec vein thrombosis, which explained all his symptoms. So my first lesson was Listen to the patient. Even the ones you you may think are complaining a lot They're not. They have a good reason. And the second one is document accurately with date time, no name and your role, every entry in the notes. It is good practice. I didn't pass my primary for RCs first time, and, like my entry into medical school, took 26 applications. But if you're determined, persevere, you will get there and part of the journey. It's being determined and to persevere. My first experience in garlic surgery was doing a locum job at the prime of the hospital and had woken up early in the morning and went across there without breakfast. The day didn't go as well as it ought. Suffice to say I was at the table for 12 hours without breakfast without anything to eat, and the seven oh prolene became smaller, thinner and more invisible as the day man passed, much to the frustration of the surgeon. And in retrospect, I really feel sorry for them. So the next important lesson is to be sharp. You have to stay sharp yourself. Nutrition, hydration, food and sleep are vital to ensure that you are prepared for the rigors of surgery because it is rigorous. My first job is an S. H O. Was a neurology. And as I suppose, I was a bit of a precocious surgeon but within the first few months persuaded the senior registrar to take me through a nephrectomy. I did a nephrectomy. It all went well. The patient was well, and the wound at Day four looked fabulous, and the senior registrar, Ken Hastie, said, Well, done. You've done a good job. And I said the wound speaks for itself. Well, at Day five, Rune blue, Red Day six It was easy. And by say, day seven, the wound had totally d hist, much to the astonishment of the senior registrar Neurology. So this was the My next important lesson is that you can never, ever be complacent, and you're only as good as your last operation. The other consultant there, Mr William Water Frederick Salt southward was fabulous at sitting down and writing with a fountain pen in the notes. But on a ward one round one day, I referred to a patient as a chap, and he said, Mr Regan, please do not ever refer to my patience as a chap all patients'. Have a handle, a name. Inquire their name and use that name appropriately. Do not ever abbreviate it. As one of the consultants in Oxford as a patient, his name was Richard, and the nurses called him Dickie. Much to his frustration. I then went to Oxford to do general surgery and worked with a surgeon who's favorite phrase was, I've seen this once before, actually, which reminded me that a volume of experience enables you to generate a pattern of recognition and practice your clinical diagnosis, science and you operative skills. Because in those days, as surgeons, we didn't practice as such because we had an enormous amount of operating and the only instruction I had is the cardiac surgeon would just be quick. But that is nonsense is not being quick because getting the patient off the table must be taken as Derek Jeter. What I am looking for is the quality of outcome. That means that the patient does not have to have a repeat procedure. For 19 years, as I've been in practice, I've not had to do a repeat operation for coronary artery bypass grafts during my time as a session. The few people could actually teach you proper clinical skills, and even less we're able to teach you surgical skills. Mr. Southward wouldn't allow me to operate unless I held the knife properly and could cut in a straight line without bacon slicing the skin. That little detail only came to me when I started practicing in the deja with martial arts and using the sword where every movement is prescribed and described as a laugh, Mr Britain, said a Regan. Surgeons only walk down the middle of the cold or the walls are. It's physicians. It's a joke, true, but it does mean that you must be kind to yourself. You must stand tall, even in adversity. I suppose the most significant figure in my training was perhaps Andrew Turnbull, who, when I passed him to do an aneurysm repair as a messenger, accused me of being a pushy South African and allowed me to the operation. He quietly stood there during the operation, and afterwards we sat down and discussed the operation, and he said, Why did you do this and why did you do that? And that led me to think much of what we do is because of the way we've done it around here and cultivated the need to reflect on your operation and on your actions. And do they actually progress? Because I don't teach speed, but we teach deliberate, purposeful movement, caressing the tissues, making progress all the time. There's no place for a fast surgeon. I suppose the most magnanimous Surgeon daily have come across is Professor Maggie Yakub. This man had the brain the size of a planet, but despite that was extremely humble and valued terrible. I remember opening a redo for him one day, and he wanted to get on and open the second redo, and unfortunately we hit the right ventricle, he said. David put the pipes in the groin, which I did, and at the end of the successful operation, he said, David, take the pipes out. When I said I couldn't take the pipes out, he said, Don't be silly. I took the venous line and pulled it out. So imagine a sock coming off your foot in the inferior vena cava. Coming off with that, the pressure fell to the ground and he said, Give me a knife, Give me a knife I said, Professor, what you're going to do He said, I must open. I must open with my interest in trauma surgery. I said, Don't, because you'll find a venous bleed in the retro peritoneum not be able to control it, and the patient will die, he said. What do I do? Yes, said nothing. We did nothing over. So at the end the lady left hospital at seven days and I saw it three months, and she is absolutely fine. But even in that moment of emergency and extreme, Professor Yakub said, surgeons don't jump. When I say that he had the mind of a plan, it reminds me of two Japanese words. Miso know Cook aru was mind like water and be still and don't put any more effort in than is necessary to do the job and return to being quiet. But as a surgeon, the ripples you send out as a surgeon are going to send ripples through theater. The other word is Suki know kuru, which is mine like the moon, because even when it is cloudy, the moon is ever present and therefore your mind and you're thinking, despite your perturbations, should be clear and bright and shining. And that is like Mantilla Cube. There's lots to learn in surgery and knots for martial arts and the to meet because it's not just a technical skill. A martial arts is not just fighting or self defense. It's a way of life. There's a spiritualism, a taoism of Buddhism, with it in a way of thinking and a respect that's inculcated in everything we do. And as I've been pursuing martial arts, I'm thinking that sadly, we're losing that. With the exception of those fabulous people we have identified over 22 years as being some of the best surgical trainers of the land as we have for the Silver Scalpel award. So then few Japanese philosophies that I think translate very nicely into surgery. The first is what Confucius says. Everybody is the same, and there any diversify if they practice. And I think that I drink from Confucius applies perfectly to surgery. Mastery is not an endpoint. It's a journey and PSA tending to the basics. The principle behind the Black Belt Academy of Surgical Skills is to demystify some of the basics and explain to you the nuances and the reasons why we do some things, as I've learned over nine years of martial arts and my practice with a sword, there are other shames mindsets of cookers that are described. Uh huh. Children and show ocean is being open to experience. Issue is focus even on the smallest matters, because even the smallest matters, if you ignore them, can come up and bite you as a surgeon. Food and shit is essentially drive, persistence, motivation and determination because effort will triumph over skill every day, and that is the same in martial arts. And, I suppose, reflects my journey and martial arts. And despite starting late, I still reached 2nd and 3rd down. Mushin is an interesting one. It's the ability to unfocused Native Americans. Call it our allies. The FBI teaches this spatter vision, and the military call it the 1000 yard stare. Motion is the unperturbed mind, and the UN Pittard mind can achieve more. And the clarity of mind is necessary in doing any complex task, even playing sport. And you will see that many sports people clear the mind before the do the exercise, the last being sanctioned. It's particularly in sport. If you look at those people on the gym apparatus, they land and hold the pose, maintaining the focus this is completion and compose closure or pause at the end of a piece of work is that alertness and a sustained, lingering focus after what you do? And I suppose in many respects, your alertness and the sustained attention is there after surgery, Even when you close, you're still looking and thinking and following up, and that's what surgery is all about. I came across this list recently on the seven Mindsets in Japanese. I've mentioned Icky Guy. This is the reason why you get up in the morning. This is what gives you meaning to life where you bring your own strengths, values, passions and needs to your work shaky to gain. I is an interesting one. Some things you just have to let go and are beyond your control. You must learn to let go and any focus on what you can do and not what others should do. Wabi Sabi is very pertinent to surgery. Find peace in imperfection because you'll never get it right all the time. You're only as good as your last operation, and engulf your is only as good as your last game. But what you need to ensure is that you're on power, and that's why you need to practice. You've got to recognize that nothing is perfect. You are not perfect, and you need to forgive yourself for that and be kind and find joy in imperfections. And do not criticize other people's imperfections. That is totally inappropriate. Cancer G is the Japanese art of fixing broken pots where they fixed the brakes with motion gold to find a new, beautiful art come in is essentially reminded me of that. Walk down the middle of the corridor, preserve your dignity even in tough times. Exercise, emotional maturity and self control. Learn to step back and take a deep breath. Slow down when things go wrong. Most people panic. Professor Yakub did not panic. He slowed down, and that's what they teach airline pilots who by Tory is very appropriate for surgeons. Don't compare yourself to other people. We're all unique. We all look on our own journey. You're expert, too, in the Black Belt Academy, I'm a sensei. That means I'm not better or worse than you just means that I've been on a journey longer and I've got more stories to tell. Focus on your own progress and do not measure yourself against others. I recall Melissa, who taught human resources on my M B A described medical conferences as looking at a pack of dogs going around sniffing each other. It is sad to witness, show appreciation for other people's journey, value their expertise and listen with intent not to answer or to boast or to exhibit one upmanship that does not work. Kaizen refers to improving a career in surgery is a journey. You must learn to improve yourself every day mentally, physically, spiritually, clinically as well as technically, because you need all of those in your journey of surgery. To be sharp, you have to stay sharp. Look after your sleep, nutrition, hydration and obviously, avoid all substances of abuse. Remember, small changes commit lead to big things, and they have an impact of the time. Lastly, shoe Hari shoe is learn the basics and learn the basics from every mast er that you work with. Because surgical experience is a posey of other men's flowers, good or bad, you learn from surgeons. Watch, listen, inquire and put together your own closing for when the time is right, you'll find your heart and be able to integrate it into your practice. And that will lead to read where you will be able to innovate and respond to a variety of situations. Because sadly, is not a routine. Every case, every person is unique and brings a different story and a different set of potential problems. So the philosophy behind about black Bart Academy is to draw on and share with you. My stories of surgery since 1985 draw parallels with the martial arts, which, quite frankly, are shared with many sports. But I want to inculcated you an enthusiasm and urge you to find your icky guy to practice and to enjoy learning art. Remember also that you're always part of the team. And as a cardiac surgeon, I cannot do my job without 12 other people, and those 12 other people can only function well if you're functioning and exercising self control as well. I hope you're going to enjoy the Black Belt Academy of Surgical Skills this year. I'm delighted to be working with Medal because they will enable us to interview people. Well, I hope enlighten you and help you on your journey because it is my desire to ensure that you turn out better surgeons than me. As they say when the student is ready, the teacher will appear When the student is truly ready. The teacher would disappear. Thank you for joining the Black Belt Academy. Look forward to seeing you next week when I am joined by Linda Dickel side. When we talk about what it really means to be a surgeon. Thank you. I wish you well and have a very good new year. Good day. Goodnight and good afternoon.