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Hello. Good evening. Good day. Good morning. Wherever you are in the world. And welcome to the Black Belt Academy of Surgical Skills. I'd like to thank the 3260 followers on Facebook and the 510 followers on Instagram. And if you're returning this evening, thank you very much. And if this is your first time, welcome. It's a very special evening this evening because the medal platform the CEO fill mechanic is with us this evening enables me to invite co hosts to the program for your education. And I'm extremely grateful to fill for sharing the philosophy of democratizing surgical education and skills Fill. Thank you very much indeed. And thank you for making this possible. I'm particularly delighted to be joined a surgical colleague and friend, Chris Cuddy, who is a plastic surgeon, and Sheffield, and I'll let him introduce himself. Chris, Hi. I'm Chris Caddy. I'm rewired, having left the NHS. I started out in Edinburgh, and I was, um, a neuro protector for the royal culture surges of Edinburgh. And I promised when the time came, I would come back to Edinburgh. My training took me on an international journey. I went to South Africa and spent 4.5 years there to Australia two years there and then to North America, Indianapolis and spent a year there before returning to the UK. Since then, I followed a pathway which has been linked with with medical education and a particular surgery. And so I became a fellow, the faculty, surgical trainers and also a fellow of the Academy of Medical Educators. So I'm now in a position to give back to surgery. I met David through the faculty of surgical trainers, and his philosophy is very much one of my own. When I said to him, he said he set up this Black belt Academy of surgical Skills. I said, Oh, I'm actually a second down in Tae kwon do. So we share a lot together and I'm here to facilitate his delivery this evening. Thank you, David. Chris, you're welcome. And again, Thank you, Phil. I'm grateful to fill for shifting all our productions forward one week. In view of the significant events over a week ago, the celebrity and majesty of the state funeral was quite something but one element that really resonated with me. was Her Majesty's simple philosophy. I served which she did for 70 years without evasion, equivocation or mental reservation of any kind, and was always there smiling. And I think it's something that I'd like to pause and reflect on. I serve. I do so because when you think about it, we work in a health service. We are in a very privileged position to provide a service, and that simple axiom service with a smile is so important. I saw on social media the other day a teacher correcting his face before going into the classroom in front of students to put the smile on before you face the students, your face is a mirror of your thoughts, and your thoughts will come through in your facial expression. Apparently, it works the other way around, so if you're not feeling up to it, the best thing to do is put a pencil in your mouth like that, and it forces a smile. But in doing so forces their smile muscles and it gets you smiling. Well, it if it hasn't got you smiling, it now should, because that is very least, is a very silly thing to do. But there is some neuro science behind it and really, truly in the delivery of any service. There's a simple philosophy that happy staff make her happy customers, and that is very true in the health service as well. And the Baptist Memorial Hospital in America was one of the failing hospitals in it's early Days, until I realized one simple strategy, which they called the wild strategy. They would do everything anything that was necessary to make the staff happy because they knew happy staff made for happy patients. And lo and behold, within 10 years they won the Malcolm Brain Bridge Award for Excellence for a company. So the one organization on the planet that depends on making you feel good and making you feel happy is in fact Disney because in business terms of the difference between a five out of five satisfaction and four out of five, satisfaction is a 75% full in football. And I recall one of my registrars who came from America who had a summer job with Disney in Los Angeles, and he played goofy and I did a business paper on how would goofy run the N. H. S and It's an excellent book to read by Friendly 9.5 Things You Do if Disney ran your hospital. The thing is, is that surgeons are quite autonomous beings because that's the way we trained. And we recognize Tom Cruise in Top Gun here the Maverick. But actually, if you look carefully at this picture, he has a wingman and he's above the water. I know that some people leave theater and say, Are my shoes wet? Implying that they have been walking on water? I'm sorry, but there's a degree of humility that is required in the whole process of delivering a service and understanding that to fly your plane to be top gun, you're leaving a ship with numerous number of people supporting your endeavors. And mine's Berg actually said one of the most complex and dangerous environments to work in is a flat top aircraft carrier. And it was interesting that people on that flat top color coded and they communicate with each other by hand signals because of the noise we are. And I believe in a very, very privileged position, and going back to Japanese philosophies for me are doing what I love. I'm doing what the world needs. I'm doing what I think I'm good at and what is even better. I'm being paid for it. And that is for being a surgeon and this like a guy. The Japanese philosophy is the reason for being your passion, your mission, your vocation and your profession all link to the simple term like a guy. And I would like everybody to reflect on where you are within those circles because it is circles. It is the terror sign which is mind and body. And although we've been teaching you the physical attributes of surgery, there's as of alluded to earlier series a mental aspect of this as well. And this all comes back to you. You have got this in the palm of your hand and as you to look at this and we're going to offer you an opportunity to reflect on it. As developing surgeons, we are all developing, so I would like to think of the toujeo same as a fusion of both mind and body, the mind being emotional but inside is a spiritual as well. The body not only the physical but also the mental aspect. And I recall during my training, falling off a horse and breaking an ankle and walking on crutches for a week and at the end of the week. Feeling bone crepitus think this is more than just a sprain and with bank holiday Easter weekend and I was on crutches in my toes with the size of purple pork sausages. But nobody offered to do the weekend for me, and I had to hire a car left automatic drive because I've broken one left ankle. But there's lots of sympathy because I was on crutches with a visible plaster. Paris. But sometimes your injury is mental and emotional and even spiritual, and I have, like many surgeons, been through a divorce, and that pain is just as acute is breaking your ankle. But it's more private. It's inner. It's one of those inner circles. You don't wear it on the outside because it's not a plaster. It's not a plastic Paris, but the injury is just the same. And the important thing is that we bring our whole cells to work all the time, and the trainees and trainers need to appreciate that holistic huh aspect, because as my brother is a family practitioner in America, says at the end of the week he feels absolutely exhausted because and I love. The metaphor he gives is that whenever you see a patient and you invest them time in them, you're almost giving a little bit of energy, a little quantum of energy away. And if you allow that quantum of energy to deplete you, that is where we are seeing, particularly with the conditions under which we've all been working for the past two years. Burnout, fatigue, stress and sadly, even suicide has been reported on Twitter. So the Black Belt Academy this evening would like to address this problem by asking you to take a moment, take a breath and let us examine how you can manage your energy. Because without your energy and without that balance, you're not going to be able to serve and delight the customer. Your patient, as you had hoped, you're not, might not be aware of this. But if we embedded in you now, it is something that I hope you carry with you for the rest of your career because it is a long, tiring but very rewarding road. So before we actually start, we must ask, Are you heading for an energy crisis? And we've borrowed some questions from Harvard Business Review that simply require a point. If you can answer yes to the question and therefore sections your body your emotions so I'll give you we'll give you a few moments to read these and just make a note. If the answer is yes, that's the point for the body. I don't regularly get at least 7 to 8 hours of sleep, and I often wake up tired. David, can I come in here? I think it's very important that people are honest with themselves. Yes, it's very easy to look at this and think, Oh yeah, that doesn't apply to me. But if you pause and reflect and think doesn't really apply to me, I've had to look at each of these and think, How do I interact with it? And when I'm being honest, I'm not as virtuous as I think so if people can be honest with themselves, I don't need to actually read these out. But this is enormous, and we'll see the pole of the results at the end, and we'll give you a minute to read each of these slides and put a point down. If you acknowledge each of these statements one point for each statement fill, you could do the same as what I think. Yeah, I think it'll be a bit of a shock to fill, but we'll include him. I am watching the clock, okay? And I agree with you, Chris, if you're honest and actually pause, you can identify a lot of these elements. So I'm going to move onto the next slide. Read the questions carefully, please. If you recognize that, you score a point and just accumulate the points, please. So fill. Could you put up the pole. And could you submit your answers, please of your total score? Having red those 16 questions? Remember, if you think it applies to you that was at school, So I'm looking at this on this side. I'm pleased to see that people have got reasonable energy management skills, but there are some who are really flagging. Thank you for your participation there, and I'm sure we'll get future viewers to do the same. So let's take each of these in turn. The first is your physical energy and the most important thing is to actually have regular sleep now. This is a bit of a problem, isn't it? For people on call and hours. And I know to the Ted talks recently to say that sleep disruption is linked to cancer and ill health. But we can improve our sleep and rest by making it regular, removing blue screen time and reducing alcohol use. The other thing is yoga or exercise will actually help you sleep as well. One of the things that I noted after a whole day in theater that I had a headache and I was actually feeling quite up use and suddenly dawned on me. The reason for that is I was not drinking enough during the day, and I have to commend one of the delegates in a recent course of mine carried around a big water bottle all day. And it was his mission to drink that water in the day and not to put too fine a point on it. You know you were dehydrated is when you go for a P, and it's dark and malodorous. It should be pale yellow and not too smelly. Nutrition is also incredibly important, and I don't have to emphasize a balanced diet. But a good meal in the morning is important. I recall my first experience in cardiac surgery, thinking it would be a simple day and I was assisting. I went into theater with no breakfast. Things went from bad to worse. It was 12 hours and theater, and that's seven Oh prolene at the end of 12 hours. Feeling hypoglycemic was not a comfortable event. The only thing is, is that sleep deprivation and the temptation to look at all the chocolates and gifts that the nurses deservedly get at the nurse's station means that you end up grazing. And it's not uncommon to put on weight on the ward because you're grazing all the time. And something very simple that I did is take the stairs, and a normal working day could cover 21 flights of stairs a day. Next week, we're going to cover posture and musculoskeletal health, and we'll go into that in more detail. But it's important to take regular breaks, if possible, away from your desk to replenish and walk. And a colleague used to go out at lunchtime and take a walk, and I think of that film pretty woman where Richard Gere was encouraged to walk on the grass with bare feet. And there's something of being connected to the earth with bare feet. Yeah, if I can interject 11 of the important things here is to turn your physical energy into habits and to make atomic habits. So I know a Garmin watch. There are other watches available, but what this does is it tracks your sleep your deep sleep, your REM sleep and tells you how much sleep you're actually getting. And you can plot this over weeks and actually over the whole year. And similarly, it will track your body battery so it will work out how much stress you're you're working under how much sleep you're getting, how much exercise you're getting that will balance all of this out so that you can wake up in the morning and see whether or not your body battery is fully charged. You can then work out what works for you and what doesn't. You're probably all aware of circadian rhythms, but you may not be so aware of ultradian rhythms, So these are rhythms that go between 90 and 110 minutes so if you're in a lecture for 100 and 20 minutes by the end of 100 and 20 minutes, you are flagging. Your concentration is not there, and that's your body telling you to stop and do something different. It's usually get up, walk around, get some fresh air and then come back to it. So I throughout my career I felt that I was the person who was driving the whole list. So I had to be there on time at the beginning. Run the who's safety checklist and the rest of the time I was pushing, pushing, pushing. But you need to realize that this is not a solo sport, that the team work there, and the person next to you is the copilot you're working with, and you need to share that responsibility so that the list runs clock like clockwork. But it's not all your responsibility, and I think modern gadgets are making a lot of this more transparent and helpful to manage. We have mentioned sleep and circadian rhythms, and we go through 5 to 6 rhythm's at night. I I know if I'm working up between two and three in the morning it completely throws me, and that would be different for every person. But in our busy Hurlyburly day, we also need time to think time to actually refocus, reflect, and it's useful to do that and give yourself time to do that. We are bombarded with information requests, emails, mobile phones all day, every day. We need to be able to delegate designate times during the day to do this. And if you've got something big coming up very challenging, make a note of that the night before and make it first on your list the next day and grant yourself permission to say no, you can't be everything for everybody all the time and you will end up burning out. So from the body point of view, the mental and physical side there are simple things you can do, which are listed here to help you manage that energy. But there's another way of looking at things, isn't there, Chris? Yeah, So David talked about picky guy, and I had to sort of reflect upon what's my lucky guy. And what I found is that towards the latter part of my career, I was focusing on coaching, mentoring and appraisals. This allows us to introduce different lenses when we're looking at any situation. So when you're having a conversation with someone and perhaps it's not going as well as you'd like it to go, you need to use the reverse lens and think, What would the other person in this conflict say? And how might they be? Right, So you need to look for your E Q. Your emotional quotient and see if you can get yourself on to the the same level as the person you're talking to. You then need to start thinking about using a long lens. How will I, like, leave you the situation in six months? Okay, it may be really affecting you at the time, but how is it going to affect you in six months? And the other thing that's important to do is to use the long lens and then use a wide lens. So what doesn't kill you will make you stronger. So in the steward philosophy, the object is the way a more farty. It's about encouraging you to learn from every situation. How can I grow and learn from the situation? So when somebody says no, you can't do that, you need to think Well, how can I negotiate this? You either go around it under it, over it, and occasionally you have to go straight through it. But objects are there to be negotiated next side. The other thing you need to do is to look at your emotional energy and as doctors were very privileged in that we go to work and we interact with many people, the teams that we work with, but all the patients that we meet and greet, and so we're able to connect. I think one of the challenges from Cove it is. Many people have been working from home. They've been working in the isolation and they haven't been able to experience that physical reality of meeting with people. You need to diffuse negative emotions. So in coaching there's a thing called positive psychology working with positive energy's. So when you're giving feedback, it's important that you have a 5 to 1 ratio of giving positive feedback to any form of negative, to be enthused about things to be energetic and you will see the best and everything, and you'll bring out the best and everything so few positive emotions and you'll find it in others. You need to change the narrative and we said, Use different lenses. Next line, please. So spiritual energy. This often has a sort of negative effect. When you're talking to people in the West, they relate spiritual to religious, to going to church. But that's not what this is about. This is about finding your sweet spot. It's what makes you a real person. It's about looking for your values and creating those values. So my values are curiosity. I'm very curious. They're also zest, hope and leadership. So I look at every situation trying to find the answers for them. So it's important that you make time and energy to consider what's most important for you. So, for example, spend the last 20 minutes of your evening commute relaxing so that when you bend through the door, you got time to connect with your family that you're not thinking about your work, that you can be present with them and enjoy that time together. And it's important that you live your core values, find out what they are and go for them. So once again, that's part of the icky guy. It's about finding what makes you tick next slide. So questions. Do you have a coach? My response to that is, if not, why not? Um, we've all had somebody who has coached you at some stage in your life, whether you know it or not. So if you think about somebody who's had a bit of a big effect on you, how did they do that? They often did it simply by listening. They didn't have to do anything. They just need to listen and believe in you. So it's important for you to think about the role of a coach, depending on which Diener E. You work in. The diary may well have a coaching program already established. So the jar a window is, um, you have the the Forum where that's what you know about yourself and everybody else knows about it. You have the facade, which is bits which you keep hidden from everyone else. So David, explaining that he had been through a divorce that was something, was part of his facade, and he didn't want to share with others. But he's done that, and it's made him a bigger man in my eyes. You then have the blind spots, and that's where multi source feedback 3 60 feedback comes in. That's what other people see on you, which you can't see for yourself. And that's why you need to ask others for feedback the whole time because you will be blind. Too many things in your behavior the way that you respond to situations. And if you ask for comment, it will be given to you. It may not be what you want to hear, but you will get feedback. You then need to work with that. So what do you think coaching is for? It's about making you the best person that you possibly can be, and it's a process. So it's it's involved in leadership development. It's about bringing change and transformation both in individuals but also in teams. So I'm part of what's called the Flu Coaching Academy, which looks at the measles system. So you have the micro system, which is the smallest interaction between me as a medic and my patients. The missus system is a pathway, so it involves many different systems, many different people. So we did one for skin cancer, which involved primary care secondary care. It involves pathologists, radiologists, surgeons, dermatologists. So it's a whole team that's involved, and in order to coach that it's almost impossible to do with one person. So you need to have two coaches, one who is embedded in the pathway and another who can helicopter above, look down and ask silly questions. There are no silly questions, but you will reframe the situation. Get everyone to think about well, why do we do it that way? Is there another way of doing it? So this helps with performance and delivery. It's about continuous improvement of the system. It will improve your mental capacity or sharpen your thinking. It will give you a greater sense of clarity and directions. It improves your confidence and sense of wellbeing, and it will tell you turn you into a better and more consistent performer next night. Chris, I think that is excellent. And, oh, sports professional sports people actually have coaches. And I do love the analogy that a surgeon is an athlete and do question why we do not have a coach. I told Wendy has taken on the mantle of having a coach to somebody to reflect on his performance, both physically and spiritually. It is said that you want to change the world, but you first start by changing yourself. But the important thing is is not to be hard on yourself. We are human. Things happen before we stumble. We heard we laugh. We live. You've got to recognize that as part of a normal process and to be kind with yourself and to live with integrity. And this comes back to this. What are your core values and living a life of values and living a life of integrity for being true to yourself. Keeping good company, being confident, being honest and transparent, honoring your word. Being loyal and accepting responsibility. Recognizing when you have stumbled, be resilient, try and make a difference and ultimately try and live for a cause that's greater than yourself, because money and power and positions do not live longer than the moment you leave this literary abode. But values will and pass on, and that is where your true North and the leadership books called True North come in. What is your true north? But integrity, respect, compassion and wisdom, a part of that compass and moral code, which brings me back to martial arts and the development of the self because it's not only development of your skills, it's development of yourself. And mastery is not an absolute is not a final destination. We are always learning were always refining are skills, so be patient, be kind to yourself. Persist. Persevere because in the end, effort triumphs over skill. But above all, in the most difficult moments is take a deep breath, slow down exercise, self control. And this is particularly in those moments of impending disaster in theater. There's very little that a single finger on the bleed swap on their deep breath. Call for help. Ask the team, and that's what airline pilots are trained to do is in moments of chaos. Instead of actually focusing down is deep breath in and ask open questions. And the most interesting of human studies is knowledge of yourself. And managing that and I love the precepts in our martial art school is to have self control, to persevere. They have an indomitable spirit, to be courteous, to have integrity, to be humble. And above all I think, listen, because that is the greatest gift that you can give somebody as described while everybody matters. Bob Chapman as he's trying to change the world in the way we manage and lead people. We want people to be themselves, and we need to listen and respect. And everybody is an expert. Chris. Your closing thoughts Well, David, thank you for sharing. There's too much in this evening's talk. I think you have so many seeds and we can come back and revisit those to develop. But I particularly like the looking after the physical body. We scratch the surface there, and I think in the future we'll come back and look at how we can actually develop the super athletes of the future. I think if we can. So those seeds early on in your career, you don't need to go through life and end up cripple having surgery on your on your spine and having a scar on your neck. Um, but that's all about investing in yourself over a lifetime. So I think if we can build these these habits and early on, you will be much better surgeons for it. So thank you, and that gives me an excellent opportunity to plug next weeks. Black Belt Academy make a stand because Joseph Pilates actually said You are as old as your spine. And I am very concerned as surgeons that we are not attending to our posture and our spines. So if you want to know more, there is a fantastic handout done by Vanessa of three pillars on the website. Be be a double s dot org, and we'll be talking about this next week. Thank you very much indeed. For joining the Black Belt Academy of Surgical Skills. Please pass the word around. Encourage your colleagues to have a look at this broadcast, and we look forward to your feedback. Thank you very much, Phil. Thank you very much, Chris. Wish you well and be safe, okay?