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Yeah. Yeah. Hello. Um, so clearly, being a diamond sponsor gets us quite a good gig at this conference. So thank you to the, uh, to our colleagues at the Edinburgh Conference who have put in so much money for us. Um, so we've got about an hour and a half to spend with you, and we thought we'd focus on everything about being a surgeon, which sounds like a lot to cover. But I'm blessed that I've got some really good colleagues with me from the college who are going to help. Um, So I'm an elected member of Council of the Edinburgh College and I'm an orthopedic surgeon. I'm a hand surgeon, and I work in Norwich. They still make me do trauma, but we'll browse over that. I'm the cool surgery TPD for the region, and I'm currently a J C Eye exam board member. I previously was on the selection design group as well. Haroon is the past chair of the trainees committee at the Edinburgh College, and he's just got a consultant job in Fife. And he's also a past member of Council of the Edinburgh College, and James is deputy director of the faculty of surgical trainers, So he has a lot to do with with training. He's an ABC fellow. He's a spinal surgeon, apparently still okay, and he's an academic TPD. So we've got a pretty good panel of speakers with a lot of different experiences to bring to the fore as to how we can make you into fully rounded surgeons. So if we were to look back in history and just put into Google, what's the complete surgeon we get to this publication by a Frenchman? And he suggests that it's all about the use of the hand. It's all about curing diseases and the use of the hand. But we all know that there's more to being a good surgeon than just being skillful with the use of our hands. Being complete surgeon, you have to be a leader. You have to be an educator. You have to be able to manage resources, both staff and financial. You have to be able to communicate with rooms like this, and some of us are good at that. Some of the less good at that, but also with our patient's. With our colleagues, you have got to be a good technician and that is important, and so much of your training is focused on on being a good technician. But there are so many other elements that are poorly covered with within most training programs, and that's where outside resources like the colleges, can be really helpful. So why do we think it's important that you focus on all of these different areas? So for most of you in the audience, it's all about securing a consultant post. You know, you're you're starting off in your surgical career. In a few years' time, you're going to be applying for that consultant post sitting down in front of an interview panel, and you will have to provide CV points to cover most of these areas. And this is about how do you secure those CV points? How do you engage to show that you are good at all of these different areas to make yourself a fully rounded surgeon because everybody is sitting in that interview is going to be a good technician. Everybody is going to pass the exams, So what are you going to do to stand out and get that job? But it's more than just getting a consultant post because you're a trainee for a very short time. You're a consultant for a very long time, a fearfully long time, and you need to be safe and effective whilst you are in that post you're in charge of actually a multi million pound budget. You have responsibilities that literally have life and death decisions, and you need to be a good leader. You need to be a good communicator, right the way through your career. How many times do you hear of a surgeon being up in front of the G M. C because they cut wrong? Which never happens, does it? You never hear of that. How many times do you hear of a surgeon who's up in front of the G M. C. Because they communicated wrong because they made poor choices because their ethics weren't quite right all the time? That's the majority of the G. M. C's work. So being a complete surgeon, looking after all the aspects of your career, all the aspects of your personal development will save you from the G. M. C. And actually, it'll give you a fulfilling and enjoyable career because you're going to be in that job for 2025 years. So far, you've only been on six month placements, and I've no doubt that there are some of those six month placements. You were jolly glad when they ended. Well, this is the placement. Well, you're stuck in it for 25 years, so you want to be able to make sure that you can enjoy every aspect of it. That I do have colleagues who all they focus on is the technical aspects of their job, and they are jolly good at it. I think they have to find their life fulfillment outside of the workplace because it must be pretty boring going left hip right hip revision week in, week out for 25 years. I mean, really, that's not a way to live. You have to enjoy other elements of your work, and that's why being a complete surgeon by being able to offer other things to your department, other things to your workplace, other things, the professional to health, the healthcare environment is really important. So we're going to talk about security consultant post being safe and then I think most importantly, being happy and being happy is being rounded. Having a lot of strings to your bow. So securing a consultant post for a lot of you, it is that enormous hurdle. It is the, you know, the crux time of your life. Where are you going to be living? Where are you going to be bringing up your family? Where are you going to be making all those roots and setting? Setting up your homes? It's very competitive. And Rob Gregory from the S. A. C is going to be speaking later in the conference about how competitive it is currently. And he has all the latest facts and figures to share with you about what the workforce is looking like currently. But we want to help you in making sure that you're going to be the first over the line and the winner. So the first thing, obviously, in being a winner, is to refine being able to do the day job. It is important that you can actually cut that you can make good decisions for the niche of orthopedic surgery you're going to be practicing in, and that's where fellowships come in. It's very rare for somebody nowadays to be appointed to consult post without having to undertaken a fellowship. They need to be selected with care. Your fellowships. It's a balance, isn't it? Between? Oh, that's a lovely place to go and live for a year, and I'm going to get really good training there, and that's a balance you, as individuals will make. But the college can help, because the Edinburgh College of Surgeons has got a lot of research grants and a lot of fellowship grants available between you, me and the Gate Post. When I scored the fellowship applications for travel Support last year, there were really not very many applications from orthopedics, and there was quite a lot of funding dedicated to orthopedic fellowships. Just saying Apply once you've got your fellowship, once you've got your technical skills done, the next thing that they're going to be looking for in a consultant interview processes what are you bringing special to the department? What is your superpower? And we all need to bring something different to the table, and it may be that you're going to be the research girl in the department. It might be that you're looking to be a training lead. It might be that you're going to be the next clinical director in waiting. There's all these different aspects that you can offer to a department that will enhance their working ability. They they'll they'll have a list of, you know, we want a knee surgeon, but actually, there's all the other departmental jobs that need to be done that they're looking for somebody to fill. So I'm the knee surgeon. But actually, I'm a really great manager. I'm a really good leader. Look at all this leadership stuff that I've done. I'm going to lead your department forward, so you need to have more to sell than just your technical skill. Leadership comes in many shapes and sizes, many different forms. And there's many ways in which you can fulfill the leadership part of the C V. Whether we're thinking about applying for a consultant job or S t three applications, or even to get into court training. And quite a lot of people show brilliant leadership outside of the workplace, and that is still very valid. The NHS has a view on leadership and has a leadership academy, and really, because the majority of these courses are free, particularly Edward Jenner program, everybody should be able to engage with an N. H s leadership program. Edward generally is free. Takes about six weeks of time. Um, just a bit of homework on an evening. Get you a certificate. It's really useful knowledge that's encompassed within that program, and some really useful skills it rate makes you really review how you interact in the workplace. Um, and it ticks that management and leadership box. If you want to go further into leadership, as with many things, there's an alphabet soup of qualifications you can start to look for. There's PG Certs in leadership, PG diplomas, MSC's and MBS. In terms of in terms of issue, really wanting to be a leader, the N B A is probably the way to go. Mayday. Mm, thank you. Um, when you're thinking about leadership programs, there are some that are very specific to healthcare. There are some that are broader. Looking at the leadership programs that my consultant colleagues have done, there's a lot to be gained from doing a broad part time MBA. A. It's quite business focused in your local university because it gives you interaction with people who come from different worlds. One of the main problems with the N H s is that we're all very siloed. We've only ever known the NHS. All of our leaders and managers have only ever known the NHS to only ever know the NHS way of doing things. And we all know that changes therefore glacially slow innovation is slow to come in. We all have this same mind think program of the way in which things are done. So, actually, if you are ambitious as the leader, I could really commend to you looking at your local university adult education programs. And there will be MBIA's that you can undertake if you're looking for something. Distance learning. The Open University has very good offerings as well. Health, education. England and Ness also sponsor fellows in leadership, and we have ness educational fellows embedded within the Royal College of Surgeons of Edinburgh. They take an OOPSIE for a year and come and join us, and they'll be given specific projects within the within the college. They'll get access to all of the college meetings. They spend a lot of time with the president's the secretary treasurer so they really get a good grounding in leadership abilities. Um, leadership is also embedded within the knots course. And really, it's a lot of Dean Aries are now suggesting that this almost needs to be mandatory for surgeons who are coming out at the top end of their training. The nontechnical skills, we've said are the things that end up with you in trouble there, the things that make your life miserable. You know, if you're known as the surgeon who can't make decisions in theater, the theater team soon news is trust in you. If you're known as the surgeon who goes off on one. If they haven't got the right instrument, you soon lose the support of your theater staff and actually the theater staff. You're gonna be spending 25 years with them. You want them to be your mates. You want to have a good relationship with them to make your life more interesting and fun, but also because they'll have your back and they'll have the patient's back and they will help you Mhm slow on the uptake. This thing Oh, that is too fast. Um, in terms of opportunities within the college itself, I've alluded to us having the trainee fellows embedded with nest, so those of you that are lucky enough to work in Scotland. There are ness leadership fellows that you can apply for, um, for those of you that aren't so lucky as to work in in Scotland. There are other opportunities within the Royal College of Surgeons to be able to demonstrate your leadership and get involved in the hierarchy of surgery. That helps drive change forward. So we have a number of faculties within the college of which the faculty of surgical trainers that James represents is one. I got the faculty of remote and referral health care. For those of an adventurous nature, the faculty of Peri Operative Care. There's a lot going on within the college, and you can get involved with those faculties As a trainee member, we also have surgical specialty boards for each surgical specialty. They have a trainee representative on each of them, so the Orthopedic Surgical Specialty Board is always looking for surgical trainees who would like to sit on that surgical specialty board. The Surgical Specialty boards report directly to the Edinburgh College Council and the president's advise on things pertaining to orthopedics. We also offer advice to things like Nice to the Scottish government to the UK government about things that pertain to orthopedics. So if there's if they're looking to make a major change to the way trauma networks to run across the UK, then we you will be asked to give an opinion. And as a trainee, you can get involved in shaping that opinion because actually, I won't be thinkers cross. I won't be doing trauma for too much longer, but you as a new trainee thinking about a consultant job in the next couple of years, you've got another 20 odd years of doing trauma, so it really matters to you. And that's why we value your opinion within the college. The jewel in our crown of all of the committee's is actually the trainees committee, and most of the best ideas that we have within the college come from the trainees committee. You might have been aware of the Let's step it let's stamp it out campaign that we had for bullying and harassment, where the Presidente, for the first time, his life gone on road, bike and cycles around the UK, delivering anti bullying and harassment message to hospitals around the UK That idea came from the Trainees committee. Most of the best ideas that the college takes forward comes from our trainees committee. And so it should. Because, as I said, we're all getting towards the tail end of our careers. You've got a long time ahead of you. You should be shaping the career that you're going into. You should be shaping the profession that you are joining. So with that is my great pleasure to have her room come and explain to us what the trainees committees being getting on. Thank you, Haron. Right. Thanks, Claire. There's an advert for the college for you right there, isn't it? The best ideas come from the trainees. So, uh, it's a very good college to be involved with very inclusive. Thanks for inviting me to speak today. I'm Harun Raymond, a consultant in Victoria Hospital in Car Cody, immediate past chair of the Trainees committee and the past council member with the Royal College of Surgeons of Edinburgh. I thought I had quite an easy job today in that I just had to showcase some of the work of the trainee Committee. But Claire assures me it's harder than that. This is really a patchwork talk today. There's it's three big talks that I've cut down and stitched together. Um, so all going to plan, we should be done in about three hours time, right? I'm just trying to get the thing to change. Um, the point at something specific. Uh, thanks. Um, so this was my committee? Uh, when I was running the show just a few months ago, you can see it's very diverse and representative, in many ways, um, there are more women than men, which is probably why so many of the projects actually got completed. Um, there's more orthopods. You'll be happy to hear as well six of us were orthopods, which is just the natural order of things. And for the guys looking in, um, hair loss is not a prerequisite to joining this right. We also have co opted members and their pre MRCS doctors that we, um, recruit through competitive application and there to facilitate discussion on training matters, education and assessment related to that generation of trainee the F wise through to core core training. And that's just for the purposes of inclusivity. We've got two of them and they're doing some very interesting projects. But that is a talk on its own. This is our new chair, Miss Katie Hurst. She's a trainee in Oxford. Some of you might know her, actually. Um, she's very hardworking. Um, she also chairs the sustainability group, and she bleeds the college tartan. So I think you'll see some serious productivity of the of the committee in the years to come. So I'm just gonna give you a bit of a flavor of the sort of things we do. Um, and particularly things we've done over the last 6 to 12 months. This is the sort of stuff that we get engaged with. So we represent the college on a number of training organizations, including B M A, um, academy for trainee doctors group acid and many, many more. We sit on faculties within the college, including patient safety, professional standards, fst, um, a number of others. We have presence at our international conferences, and we get our message out there using publication and webinars social media. This is the first of the campaigns I was just going to touch on a little bit. We know that the surgical workforce in the UK is becoming increasingly demotivated, demoralized and depressed. Really? Um, just people don't enjoy going to work for a number of reasons. So this group was set up to investigate, to raise awareness and just really see how the college can get involved and help the term. Well being obviously encompasses a number of issues, including mental health, anti bullying, harassment, uh, social well being, workplace, well, being nutrition. But this group was specifically looking at social well being. The next phase of it is to look at workplace well being, and then there'll be a phase. After that and the prep, my predecessors looked at things like anti bullying, which we'll touch on as well. So in terms of what we've done so far, well, we have an online webinar portfolio. We did three. This year. We have a yearly online webinar webinar based campaign for well being, which usually runs ahead of our international conferences and at those conferences will usually have a physical presence. The webinars that we have are usually chaired extremely well, and we have extremely interesting guest speakers, and I don't know if any of you had the opportunity to look at them, but they're usually, um, sort of a lot of discussion, uh, involved in those? Uh, so these were the title's for this year's Webinars, and this is just a little sample of what they kind of look like, really Box standard stuff. This was this webinar here ties in quite well with our notes program. So are non operative and nontechnical skills. What does it stand for again? Yeah, you know what I mean? Um, and then we have another one here, which is, um, quite interesting. We brought on a lifestyle medicine doctor who encouraged the viewers to reflect on their nutrition, their health, their energy management, their self care. They're stress management, and she kind of offered strategies on how you can deal with that. We also had Andrew Sutherland on Who's a really interesting guy. He's a transplant surgeon from the royal Infirmary, Uh, Edinburgh and he talked about work, life, balance. But the most interesting thing that he talked about is he's climbed Mount Everest. So how he sort of paired that up with his life and how he prepared for that very, very interesting talks I'd encourage you to look at this was actually my favorite, which was essentially a webinar. Looking at the surgeon personality and the stereotypes around surgery and whether we can change them or whether even we even want to change them. It's, um, looks at the difference between personality and professional behavior, which is quite interesting. And a few of those guys with my former mentors So, um, interesting to look at. I'm not going to give away too many spoilers because I'd like people to actually watch these webinars, Um, and the links are in the website. We had presence at our conference this year. Uh, this was our stand. You can get those soft, fluffy unicorns at the front if you're particularly interested in them. Um, students and junior doctors seem to gravitate towards us. So there are people who are still interested in surgery very reassuringly. And there are people more specifically interested in the training behind surgery. I just thought I put this slide up because, um, as part of the campaign, some of our committee members even put on a yoga, um, sort of demonstration for the for the guy. You'll be happy to hear no one broke anything, right? This is the next thing. I think this is quite important, actually, I know, every organization has its own iteration of a sustainability group. We've got sustainability group within the college. I'm just going to reiterate some facts I'm sure some of you are already aware of. The NHS is the largest public sector contributor to carbon emissions in the UK It's surgeries 3 to 6 times higher in terms of energy intensity than any other hospital department. And the average average carbon footprint of a single operation in the UK is like driving from Southampton all the way up to the Royal College of Surgeons of Edinburgh. So quite high. Some of the humbling facts that got me locked onto this issue. We use over a billion, um, disposable gloves every year. One in 12 cars on the road are related directly to the NHS, Um, and a lot of the disposable equipment that we use in A and E and in theaters usually made in Pakistan, often by child laborers. So, you know, there's a sort of moral duty here as well. Most of the work that the NHS put into tackling this problem is based on supply chain, but there's actually a lot we can do as individuals more specifically a lot we can do. As as surgeons, we can focus on our commuting, our energy consumption, our equipment usage. But all those things are really working towards the top of this pyramid. Um, maintenance or repair and recycling. Obviously, if we don't have patient's coming into the hospital, then we don't have to use the equipment on them in the first place. So I think we're also duty bound to work at the bottom of this pyramid and prevent surgical disease where we where we can. Some of the trainees might disagree with that because it might reduce their numbers overall, but it is important. So how can you actually get involved? Well, it's okay to question old habits. And if you just look at these six hours, even if you were to pick three of them and address them, turn them into a quality improvement project or something, you'd be making a massive difference. Um, you know, it's marginal gains that make the winners, and I'm sure you're all familiar with the sky story there, right? So what did we do as a college? Well, we looked at the whole patient journey from beginning all the way through to end. Um, we try to address areas that we could get involved in, Um so, you know, starting from the start things like not bringing patient's directly into theater or having direct referrals. Diagnostic hubs, telemedicine, patient empowerment, virtual consultations, rationalizing preoperative investigations, limiting hospital and healthcare visits, reducing prescriptions and lifestyle advice in terms of anesthesia actually are anesthetic colleagues are miles ahead of us. Um, when it comes to this, they are also the biggest culprits. Because, as you will know, inhalational agents, um, contribute to the biggest footprint of the sort of G A G A procedures. And actually reducing inhalational agents can reduce the carbon footprint of an operation by almost a half. Somewhere between 30 and 40% is more specific. In terms of us doing surgery, we should focus on things like reusable equipment, reusable textiles, theater hats, gowns, drapes, trolley covers. And I think Claire was saying some trusts are already doing this. Sure, A minority of trusts. Um, we have reusable hats in my place, Um, in terms of avoiding unnecessary interventions, you can think about giving people local anesthetics rather than our regional anesthetics rather than general anesthetics. Avoid single use equipment and waste. Segregation is obviously important as well. You should think about things like using alcohol in between cases rather than water every time you can wash at the beginning of That's actually a bit unnatural to say as an arthroplasty surgeon. But you still, um, you know, you can still get away with alcohol cleans in between, uh, during surgery, reduce any unnecessary items, opt for reusable and reloadable hybrid alternatives. If you can, um, use low carbon alternatives if you can. After surgery, you know, waste segregation, power things down. Don't power down your emergency theater for obvious reasons, but empower everything else down, right? These were our targets. And we do have collaborators as well. In this, the most important thing that's come out of all of this is our green checklist. Um, I'll just get to that. So we've got this. I think we'll recycle this. But this is just 12 steps on how you as trainees can get involved in sustainability, um, and reducing carbon emissions. But the thing that we've produced is a screen theater checklist. It'd be really good if you guys could introduce this. You're probably thinking not another checklist But it's just at the beginning of the day, and it's just to raise awareness on where you can sort of reduce your carbon emissions. This is going to be widely, um, put out there through media. Uh, and it has been done in collaboration with. It's an intercollegiate approach in terms of what we've done as a college, we're trying to get this introduced into exams, so awareness of reusable XYZ and sustainable surgery. But as a college, we've also, you know, our assets. Now we use less water bottles in our hotel. You know, there's no single use cosmetics, low energy lighting. Um, we've reduced sort of waste disposal and a number of things we've done. This is our sustainability group, um, within the college. The president's is directly involved in the past presidente now, but remains involved with Mike Griffin. That's Katie Hurst, and you can see Nathan Stevens there as well. You can see from Nathan Stevens there. He's holding the cup. You don't have to be extremely good looking to be part of this group, and with that, I'll just go into bullying undermining um so again, just flying through a talk that would take you know easily. Take the guys that I've done this work an hour and a half to give. We essentially know that bullying is an issue within the NHS. In 2021 there was a survey done by the NHS, and it showed that 19% of staff experience at least one incident of harassment, bullying or abuse within the previous year. And that's just simply unacceptable because we know that it creates adverse events, creates medical errors, and it increases peri operative deaths. The college simply has a zero tolerance approach to it, and this group here, the anti bullying group, was set up by Alice Hartley, one of the former chairs, and has run together with David riding. They've done an exceptional amount of work on this. I'm not sure it's you know the awareness. You know, we're always working on getting increasing awareness on these things. The group's aims were to investigate, address, lack of resource and then create a consistent set of standards and key performance indicators that trust could be held to. The first thing they did is create this online resource. Um, it's an anti bullying toolkit. I'm not sure if you've ever seen it. You don't have to be a member to access this. It's actually free to access for all, including the public. And it's really worthwhile looking at. First of all, it creates makes clear definitions between you know what, what is legal and what is illegal because some things that we actually consider as workplace bullying may well be illegal. But this is an exceptionally good, easy to use resource to have a look at. It's on our college website. The next thing that this group did is they approached a number of organizations. Um uh, these are the badges for them, and they got them to sign up to this. Um, it's like an anti bullying alliance. So they created a consistent set of professional standards and got these groups to sign up to them so that we're all singing from the same hymn sheet, and we've got a sort of unified approach to this. It's a It is a campaign that's led by the Royal College of Surgeons of Edinburgh. But we're also partnered up with the Royal College of Obstetricians and Gynecologists on this as well, because they had very similar, uh, objectives, and this is what we eventually produced. It's an alliance document that's been signed by all of these organizations as well available on our website. Um, and these were our aims. It's for visibility, standards, education and to protect the people that are at risk. It has been I mean, you probably probably find that affect. Probably find that a bit offensive. But the reason that David put this on on there is because it has been rubber stamped by the Department of Health worth knowing, Um, we are looking at, uh, in terms of our next steps looking at addressing or, um, taking this on with the groups most at risk. So there is a systematic review done by our college members in 2018 and really just kind of scientifically shows you what we already suspect. That women, people from ethnic minority groups and non heterosexual individuals at highest risk of being bullied or harassed in the workplace. So we're doing some work along those lines, right? I think we're taking questions at the end, so I'll just hand back over to Claire There. Thanks very much. Thank you, Darrin. And you know, he's so humble because the trainees Committee has a massive influence on the college and its activities and therefore by didn't on surgery in general. So at the at the president's try annual meeting, which is one of the flagship meetings of the college well being with, really, to the four pushed by the trainees committee, nearly every talk was on well being. To the extent that I had dinner the night before with a Respi Deitrich respiratory physician, he was terrified at the prospect of speaking to a room full of surgeons. He felt like Daniel in the lion's den. And then he gave his talk and the audience was spellbound because everybody is into well, being at the moment. Everybody wants to look at How can we look after surgeons to enable them to look better after patient's? So the Trainees committee is very influential. It's influenced me. So in my theaters, now we're on reusable gowns were on all regional anesthesia. We've got recycling waste streams, and my current trainee is is doing a Q I audit of that, and that's going to be publishable. What's not to like? Everyone's a winner. Um, so who in this audience would regard themselves as being a trainee hands up pretty much all of you. Then, um, who in this audience would regard themselves as a trainer? Thank you. You should. You should all have your hands up. Really? Because no matter what level of surgery you are working in, no matter what your role, you are acting as a trainer to those two less experienced than yourself. And it may be somebody at the same level who's less experienced than yourself. It may be somebody who is more junior than you are that that needs the training, but we are all in this room trainers. And as we go forward in our careers, we have to have a life long commitment to training others to training the J generation behind us to training the generation who, let's face it going into my hip replacement. So all helps off to the to the arthroplasty surgeons. So it's my great pleasure to introduce to James Tomlinson, who's the deputy director of the Faculty of Surgical Trainers, which helps improve standards for surgical training across the UK. James, thank you. Oh, hang on. My slides have vanished. Who? That will be a short commercial break. Anyone good singer anyone want to sing a song for the audience? Share the stage with you. Amazing. Thank you. Um, right. Paul is good again. Hi, I'm James. I'm a spinal surgeon in Sheffield and clearly spinal surgeon to have a reputation. I'm all right by spinal surgery standards, at least. Spinal surgeon. Uh, if there are any questions or you want to get in touch with me or tell me I'm wrong, but you don't want to say it to my face, my email and Twitter that and you're really welcome to get in touch. Um, I don't have any financial disclosures relevant to this talk. Um, I do think I have to say I felt really conflicted about giving this talk That, um there is a slight irony about being asked to talk about high quality training when you work in a unit where the training is poor in a region where the training is poor. So if anyone's here from Yorkshire and you want to take a shot, I'm here. Go for it. Um, the irony isn't lost on me. I'm so training. Uh, this is a dictionary definition that Axion of teaching a person a particular skill or behavior Sounds pretty simple. Like, how complicated can that be? Surely it can't be that hard. So you we should all be able to make your amazing surgeons. I was kind of trying to, um, think about, you know, how do you put that into context and helpfully, the Lancet help me out here that this is literally, uh, last week, front cover of the land set Sciences. Important education is the vet that transmits to every new generation. Curiosity, passion and commitment to reimagine the future extends the limits of possibility and achieved the more just social world. There is no way I could have spent the next 20 years right in this talk. I wasn't going to come up with anything quite as poetic as that. But I guess that's the point that I would say training is literally the future of our profession. It's the future of patient care. It's the only way we advanced things. And it is absolute critical importance. And I agree absolutely nothing. That's been said by the other two speakers that you guys are the future. We depend on you. We need you to be great trainers, and we are absolutely stuffed without you, the profession needs you and we need you to be create trainers and the faculty once you help you do that. And then I tried to kind of find a picture that this was my attempt to thing. You know, what does it feel like to be a trainee at the moment? And I got this picture is, like actual, you know, to really kind of recreate what it probably feels like right now. It's kind of shark coming in, taking the back off the boat and a meteorite kind of coming about it. It's a pretty tough time, isn't it? We've lived through a pandemic. Training has been really difficult. You guys have probably been some of you. Many of you probably exposed to things that are more traumatic than many of us had seen in our careers to date before that happened. And maybe more traumatic than anything you will see ever again In your professional lives, there is a cost of living crisis. R F one gets paid. What? I got paid in 2002 and I got free accommodation. I didn't have to drive to work. I work crazy hours. I worked 85 90 hours a week, most weeks. But the cost of living was a whole lot less 20 years ago than it is now. And I think it is really bloody hard being a trainee right now. It is really, really difficult. But we need you and we have to find a way of keeping you guys engaged and keeping on board and getting you through this because what you've been through will make you amazing. Empathic trainers who will really, really get the generation coming through. And again, there is a clear generational tension of old duffers like me. There are two quite young, but there is a There is a generational expect that people certainly people ahead of me and me to a point. There was very much. Well, I'll just do whatever I need to do to get to the end of this process, and I don't care how much I work and I don't care where I move And I don't care how many friendships I eat up along the way. Quite rightly, there are a generation of people coming through are going to feel really differently about being surgeons, and I think you guys are the generation that's gonna bridge the gap between some of the and I do include even newer consultants who saw this differently. And the people coming behind you who are going to see it really, really differently to us and even differently to some of you and you guys are the kind of glue I think that's gonna stick us all together just to have interest. Who in the room has given a presentation anywhere on something to do with training? Just stick your hand up. If you've given a talk on something around training, it's a decent number. Who's published? Abstract letter. Anything on on training paper? Again. Good number. Who's got anyone done? A postgraduate qualification at any level. PG certain up. Yeah, So when I was a trainee, if someone would have stood here and asked those questions, that would have been a lot of furrowed brows and a couple of hands from the anoraks at one end of the room. So I think things are really changing that they really I can. I was thinking that I know of at least three orthopedic. Two of them are still trainees. I think once now consult with at least three people in the UK with PhDs and orthopedic surgical education, and the idea of that 10 years ago was non existent. So I think we're we're really seeing a change, a big change in training. And you guys are already expert trainers and getting a real knowledge on what good training looks like a stage way earlier than a lot of us did. And you have huge potential. I'm going to go a bit bigger than the figures quoted earlier. But sixish years as a registrar, I accept that you may take time out. You may go up. You may have parental leave. They work part time for a while. Six ish. If you're consultant at 35. 36 based on current pensione age and you work to retirement, you will be 33 years as a consultant. And that's probably gonna go up and be nearer 40 if you retire at pensione age for some of you guys in this room. And I think no matter how hard this is, hang on. We're going the wrong way here. Can we go back, please? The clicker, Uh, no matter how bad it is and how bad the stormy seas are like you guys have huge potential to make a huge difference for a really long time. And please, please, please stick at this. I'm not trying to make you miserable. Um, I think just doesn't decide the other thing, I would say, Like, I remember starting on day one as a consultant. And if you agree, clever, You kind of going on day one and park your car and you're like, Whoa, like I've spent the last six years of my life rotating and I'm just like, Hello. 30 years, like every Monday morning, I'm gonna drive to work and park in this space and walk to the office Still being grumpy about whatever I was grumpy about last Monday. Um, it comes with security. It comes with a more predictable working life. Often you have set days off. You know, I know my own calls, usually 10 months in advance, because we self wrote her. But equally it comes with I'll never really see anyone else operate that much. I won't get to go and learn from other people. I won't get to do any new things. I'm kind of laid out my stall now and I'll do a few bits and pieces. But this is my life now and it don't rush. But don't wait too long either, I guess, is the message. So what does the faculty do these that we We went to a kind of big rebranding statement last year. And in terms of what we want to do, we want to support and nurture a diverse and inclusive community of trainers. And I think this is This isn't kind of for the, you know, you have to be some kind of training anorak who's like a great journal of surgery last month. Great article wasn't there. This isn't for the niche. This is for everyone, because we want everyone to be involved. We want everyone to feel welcome. We don't want people to feel this is a club for certain people. Anyone's welcome, because what's the goal? The goal is better. Training to define. Promoting uphold standards of surgical training will come onto that, and I think this is a key one to recognize excellence. I had dinner with a friend last night who's a medical director, and it was really interesting trying to who said the NHS is great that. You know, it's kind of a pretty equal. If you're a consultant, you get paid, you know, you get paid a set amount and everyone is treated the same. The real problem with that is I have people in my department who go above and beyond. They do way over their hours. They strive for excellence in everything they do their outcome. Data is in the top 2% in the country. If I ask for anything, they'll do it. I have no way, financially or otherwise, of recognizing that I can just send them an email and say Thanks. I really appreciate your effort. And ultimately, no matter who you are, if you're human being one day, you wake up and think, Why am I bothering? Because no one's actually noticing. I think this recognition of trainers for excellent and striving is really, really important, and actually what and again this is gonna be done tomorrow and sorry for the very pro Yorkshire. This was the only recent reference. The boat a trainer of the record. Fine. It's not like I'm being a bit pro Yorkshire, but there's the boat, a trainer of the year. There's the asset silver scalpel and now the silver suture and the F S T does have a, uh, an F S T medal, which was awarded every other year for outstanding contributions to surgical training that isn't even always awarded. Um, if it's felt there isn't, uh, an applicant of a high enough standard, there's just no award. But in essence, there are three awards in the whole of the UK to recognize brilliance and surgical training. And there's a lot more than four trainers taking it like there's hundreds and hundreds and hundreds across the surgical specialist, if not thousands. So it is hard, and I suppose this is part of what the faculty wants to address and what do we look at? So we look at teaching and training, and I I can't be completely transparent, tell you what the scoring system is, but teaching and training part, you know, the day to day stuff. Do you teach? Are you involved in regular teaching activities, educational scholarship presentations, publications, higher degrees or supervising higher degrees and then educational leadership so committees or that kind of stuff? And that gives the school. And then there are three categories anyone can join as an associate, you can just approach the college and say I'm I'm involved in training. Here's a letter from someone of support to say I have a role in training and you will be admitted as an associate. Um, membership. Uh, there is a threshold to score past, but it's open to anyone. You just fill in this two page form aligned with those criteria that kind of cross references your CV, Uh, and if you cross the threshold, you will be offered membership. You get post nominal MFS t yet, uh, and you can you are invited to a diploma ceremony if you want to attend to receive that much like it would be a MRCs or F R C s. And then fellowship. I am. I will briefly touch on this can of worms, and Mr Fleming isn't here to have an argument with me. But fellowship is only open to consultants. Um, is that how it should be? I honestly don't know personally, but the opinion of the college and the faculty as a body is that fellowship should only be allowed to be consultant level, uh, appointment. I mean, why wouldn't you the left want the letters F F s on your C v. I mean, that's a pretty cooler abbreviation to have on your CV. Um, to apply for fellowship. You need it is quite there are 250 fellows in the world, so it is quite a high standard. If you did apply as a trainee or as a consultant for membership and we think you are eligible to be a fellow, you'd be contact until actually scored very highly. We would love to appoint you as a fellow, and you then are asked to submit to references from people you work with in support of your application. Um, and then you can either choose to have your certificate posted out or come and collect it. Why would you join? I think the top left is a big one, and I find it. It's a community of practice for trainers, and it's it's not just trainers across all surgical specialties. So the nice thing is, rather than all the society and B o a meetings you there's much more cross pollination across specialties. We run a lot of webinars. They are free to anyone. If you want to kind of dip your toe in the water again. David O'Regan, who is the past director, did an amazing job through Covid of running some really great webinars, which are worth a listen. There's a conference, which is next October in Edinburgh. Uh, it's on a Friday again that's open to anyone who wants to come along very open to trainees. If you want to come along, your interest in training there also abstract submissions. We also run a grant with as many of up to 3000 lbs to fund research and surgical education that's awarded at the meeting. Um, and then there's a push to kind of start fst getting involved in designing surgical education research projects as well. Uh, in the UK The other thing with the conference, if you are a member or fellow and if you're aligned with the Edinburgh College, FSt is free of part of your college subscription. If you're aligned with any other college, it's 10 lbs a month to join the fst, give or take. So a pint. If you're these days, Um, and you get a discount on the conference, which is more or less the same as the membership fee. So it's kind of worth doing. And again if you're a trainee, if you're a member of the faculty, great when when you apply for consultant jobs of saying an external body has recognized that I'm making significant contributions to training and has kind of validated my credentials. And this is a This is a fantastic document. If if you just Google fst standards, stick this on your trainers desk like accidentally print it and accidentally leave it on their desk. This was a huge amount of hard work by Craig McClenny, a urologist in Scotland, too. Is that career advice of sending someone like If you ever see Craig name on anything as previously having been involved, don't go near it because you'll never be as good as him, No matter how hard you try. He is quite the force of nature, but this is built. This is built into I SCP as well as you come into a second a seven domains, and it kind of gives really clear guidance to trainers of. This is what a good trainer does in this area. This is what an excellent trainer would do. This was going to be mandated for trainers as part of our revalidation and that you would have to map your trainee supervision to this document. And I don't know the details, but somewhere that was watered down by the G. M. C. And it was agreed it wasn't mandated. But it's worth looking at this for the senior trainees amongst you are gonna be trained as soon I would get this and kind of use it as a reference guide for the people who are more junior. Stick it on the boss's desk and poke them in the ribs and tell them to read it. I s C P again can of worms number to throw a hand grenade. Um, I'm not gonna get bogged out. This isn't perfect. I agree. Well, part of that conversation. But within I SCP when you go on onto it, any consultant, You guys don't have this yet when they log in. If you go tell them to look at the top right there is a trainer area. And if you click on that trainer area menu, you get something that looks like that as a drop down menu. And there's two key bits of this. I want to bring your attention to the training questionnaire and the assessment summary training questionnaire is very Get rid that. Can we just go back again? Sorry. Uh, one more. I'll show you that training questionnaire is good. Um, to a point. So I have to nominate Trainee. It gets emails to you. You fill it in, I think. Yeah. Not going to say anything bad about Tomlinson. I'm not going to commit career suicide here. The good thing is, the feedback isn't released until five people have filled it in. So only when. If I only have one registrar a year, it will take me five years to get it filled in. But it will not release that data until five people have filled in. I fully accept certain people tell I'm sure you guys have had written feedback Where you think I know who wrote that? Even though this is anonymous, because I know how certain people phrase things. So it's not perfect, but it is good. So let's have a poll. How many trainers across the whole of UK surgical training have one full sets of had five trainees fill this in for them across the whole of surgical training. This is every specialty UK wide Someone shot a number to blow me out A little pessimistic. Aren't you anyone want to go higher? Was that three or 300 300? A bit more optimistic about 45? Um, it's a 45 trainers in the UK of US. Five trainees feedback. And I suspect actually, reality That's a lot of people don't know about it, but I would encourage your trainers to use it. And this is what you get. You can't export it, which is a real floor. So these are just a couple of screenshots, but you get a quant bit, which just says, um, try to minimize this and that hasn't worked. Ignore the name. You get some quant data which says a whole list. There's about 15 of these domains of Do you do this all the time sometimes. And then you get this bit which is actually really helpful, some some qualitative feedback where people can just let rip, um uh and actually, uh, I think it's really useful as a trainer that even if you think you're doing okay, you don't get any feedback, really? And you don't know, and it is really, really useful, and a couple of times I've had training say, really helpful negative things that I thought, actually, I need to do that. I need to change that And I don't think any. I could have spent years asking them face to face. They wouldn't have told me. This is a really powerful tool. You can all go back to work on Monday, again. Poke your trainer in the ribs and go look at this interesting box ICP up here. Wow, I wonder what that does. Let's have a click on that menu and this is the other. If you just want to shame your trainer and kind of, you know, start the league of shame again. This is quite a useful metric. So when on the menu, if you go to assessment summary I A CP automatically records for every trainer. How long does it take you to fill in a workplace based assessment when training send it to you? And how does that compare to the system average? And again, this gives lots of other metrics about how many words do you write on each form you fill in, and which quartile does that put you in nationally um, maybe a job for Botha, because I don't think it can be done at single training level. But I would say there needs to be a real push from trainee committees from Botha from Asset to say, Hang on a minute. What if we have to produce all this data for r A R C P? Why don't trainers have to produce this data for a R C P? Because it's great sitting here telling me I've only got four p b A s. But when you see the bosses date that they take 38 days to fill in an assessment form, I'm not the problem. And if there's data going back five years, there's a pattern here, and it doesn't matter what they say. They can't argue, because this is robust, computer generated, independent, objective data. No pressure, voter. But no, please, please. If you guys are happy to take that, I think this would be a huge step forward because there needs to be much greater challenge of trainers that there are plenty of trainees who get a lot of grief for things that are not their issue. Uh, final bit and again, excuse that my name's on this, but this is a great paper actually written by a couple of the Yorkshire trainees on behalf of the F S t. About what does good training look like from a trainee perspective? What is it that trainee wants from their trainer? And how do they want their trainer to support them? And then Alex, who's the director of the F. S t. And I've been a little bit about the trainer perspective? If you if anyone hasn't got open access to think, you can email the F S T email on the college website. This is part of the college reading list. Now for the fst. They'll just email you the document again. You can print it on Monday morning and accidentally slide on the boss's desk and then I think, just a little bit about training to finish off. And if anyone tells you a lot, you don't work hard enough and you need to do 10,000 hours. I was gonna say Shoot them, but they can be seen to be condolence violence. So the next time a consultant says you're going to be a rubbish surgeon because you haven't done 10,000 hours of surgery, let their car tires down and steal the windscreen wipers. They won't do it again. Um, why am I saying that? Say that work was described by K, and there's Ericsson and sport a way ahead of us here that if you're an elite athlete, no one goes. I'll just go and play basketball a lot, they say to a golfer. Stand there, hit the same shot 50 times and we're going to tweak one little thing every time. And then we're going to talk about what changed when you changed it, and we're gonna video it and we're going to break it down. So it's not the amount of time. It's how you do it. Um, if anyone's in this guy. Richard Resnick is kind of way ahead of anyone else in the world. He's now retired, but about 2012 they did an amazing project in Ontario, in Canada's where they said, right, let's just throw everything out the window. How quickly and how well can you train an orthopedic trainee? And I think the bit that you have to know about this is they were given millions of dollars to fund training in one center as a pilot. But they showed you could train someone in 2.5 years from zero. How they had a three month boot camp where people did no clinical work and they were just taught day after day after day after day. Here's how you drill Here is high. Put plates on. Here's how you do nails. Here's all the anatomy. And then as you finished that each trainee had a secretary and every morning you'd be told you're on DHS block. There's a DHS in that hospital this morning and you're going there. There's a DHS in that hospital in the afternoon. You're going there tomorrow. You've got your bespoke hip fracture training. Uh, in the afternoon, you're going to a different hospital again. But they showed you can train people to a really high standard really quickly. That project has been abandoned because it was the cost were literally unsustainable. It's like we're going to spend millions of dollars a year training, one program and and no healthcare system in the world can sustain that. But there's a gulf between where we are now of wandering round. Oh, you know. Hello. I've seen you for three weeks I've been on nights and all the rest of it. And do you remember my name? Uh, versus that? I'll try and say this diplomatically. Everyone gets very excited about VR and robots. Um, like we don't need V r and robots. What we need first is to work out how on earth we maximize opportunity in theater to train people effectively and get the most of that opportunity. Because actually, to use any simulator, well, you need to remove a trainee and a trainer from clinical care, and that has a massive cost. Uh, the urologists have an amazing boot camp. Uh, you run a national urology boot camp, these good friends of mine. So I'll try and be diplomatically. It's amazing. And it has lots of simulators. 60 consultants take a week off work to run it. So the cost of that boot camp is 300 days of consultant study leave. Or it's the equivalent of one consultant taking more than a year off. Work is the like. It's basically NHS loses over a year of clinical activity to run a one week training camp. Think how many patient's can be seen in clinic and operated on in one year of clinical activity. And, yes, all this stuff is really exciting. But unless we completely changed how we fund and structure training, it's a bit of an elephant in the room that actually what we need to focus on is how do we re jig and revamp on the job training? Because that's what we're going to have for a long time to come because we don't have the money to do things differently. Um, if I ever rule the world, please help me do that. We need to stop doing this, you know, all surprised curriculum change. You just thought about C. C. T. Actually, we're not going to tell you what the new rules are. See if you can guess or you guess wrong. Um, this isn't fair, is it? Uh, lots of systems in the world. If they change their curricula, it changes for the people coming in. And if you're already in training, you stay on the old curricula till you leave. And I think we need to get better at this. This isn't fair. Um, I can't change it yet. I'll keep boring people about it on your behalf and maybe we'll get that one day. I think it's another job. The fst. But actually what? What is good? That's come out of this. Can we go back again? Sorry, I will learn eventually. This clicker doesn't like going back and again. Please. I'm Claire's kind of said this already, but if you look at G. M C data literally, no surgeon ever has been in front of the GMC just about for their technical ability. It is all non technical skills. If you look at Royal College of Surgeon reports over investigations into units who are out lies for outcome data. 80% had problems with teamwork amongst consultant surgeons. That's pretty damning. Um, if you take that a step further, Michael West got some great data from the NHS staff survey if we changed 5% more of NHS staff who work in a team in inverted commerce, and we changed that so that team functioned as a true team in line with the academic definition of what teamwork is. 3% drop in mortality, so three and 100 patient's not that just by teamwork. So again, a robot. I like robots, really. But a robot isn't going to change that. It's not going to change mortality. Teamwork will, um, if you haven't done a knots course, I would say this is the most powerful course I've ever done in the whole of my training, transparency and part of faculty now so but we've had consultants of 10 years. Come on that course and say, I wish I'd done this years ago. That's the most useful thing I've ever done in my career. And I'm going to be a very different consultant from tomorrow onwards. Um, Steve, you'll who's kind of the pioneer of this is now back in Edinburgh. If anyone wants to see this guy's a superstar and and again, if you're on Twitter, follow. So Steve's doing some amazing work, and I think this is, You know, this is out there, but go to a baseball team. They can say that their best picture pictures of this many miles an hour, and when he gets below this many miles an hour, he's getting injured. So he's resting and his performance is dropping and they can tell you every metric about one of the baseball players. And there are many exciting outcomes from baseball surgeons. We work out if people live or die. We have no idea about surgical performance. We have no understanding of what influences the surgeons performance. Are there days where they shouldn't operate? Are there days when they maybe shouldn't be the major trauma on call? Because they're going to make some bad decisions because of some physiological data and Steve starting to do some really amazing stuff looking at kind of physiological monitoring of surgeons under pressure to start understanding? Actually, can we start building a model of surgical performance and having much more scientific approach to what actually is good surgical performance? And can we see that people are about to have a bad day and just stop them having it by saying right you're not operating that day? One of your colleagues, I mean, this is kind of years off being complete, and the other thing, they're really good piece of what they're doing. There's a big $5 million study in the U. S. Looking at nontechnical skills in cardiac theaters, whether that influences patient outcomes of getting that right. So he's doing some super cool stuff and definitely definitely look him up. If anyone's based in Scotland, trainee level. He also has a research program. And if that's the kind of thing that might interest you, he's probably one of the best people in the world in this field worth getting in touch. And I'm gonna kind of, I think, one last thing to touch. I think this is another really important thing in training that we need to get better at. And he's here. All these people are in the audience. Think somewhere. This is three Yorkshire trainees. You've done an amazing job and rap in particular, who led this work. But how do we support people again? Don't hear this the wrong way. Getting a consultant job. Great, starting as a consultant. Bloody terrifying. Sleep well before you start because it's probably 12 to 18 months of feeling pretty nervous. Sorry, mate. Um uh, it's a hard time and I don't think we support people well, and actually, this has given us some data to show that no, we don't really support people well, and we I think we need to get much better from a training point of view at pre consultant boot camps and transition training and supporting people in the application. But also supporting people into that process and even both from trust and probably externally supported when they start in that process. So people thrive from the off because again, we want you guys to be brilliant consults we don't like. It takes huge amounts of effort and money to get you there, and when we do get there, we want you to thrive, not sink. So I think back. You know, I think it's important to I was really conflicted about agreeing to do this talk today that you have to acknowledge. It's all a bit rubbish at the moment. I'm not like we're not in the promised land and it's awful and I hear you. And if you want to ask loads of aggressive questions about why it's so bad and why it's all my fault, knock yourself out fair play. I would, um but I think as a profession there's we really are a tipping point that we have a kind of sliding doors moment ahead of us that this is going to get better and we need brilliant surgeons and there's a huge sea change. The new curriculum people are talking differently. Hearing consultants about non talking about nontechnical skills 10 years ago, it wouldn't happen. Uh, and you guys were really, really different generation. And you have the power combined with the science that's coming to have a paradigm shift in how surgeons work, how we deliver, care how we deliver training, Uh, and the quality of what we do and you guys can literally change the world. So I think my message to you is please stick with it. Please don't give up. If it's not right for you, walk away. But if you think it is for you, but you just finding it hard, Please, please, please find a way of staying and navigating through that because we need you and you guys are gonna be in a position to achieve amazing, amazing things and make the old duffers like me pretty unemployed pretty quickly. So I'm getting the glory while I can and being on the f S t. But quite seriously, you guys can be amazing. So thank you for the investment hand back to Claire. Who's going to think? Talk about research, which is something I know not write a lot about, so I can't over to her expertise. Thank you James. And yeah, he's an academic TPD. He doesn't know about research. Just saying so that was a really great talk. And, you know, I hope you're inspired. That certainly is the Adam College. We've you trainees as the future of the profession. And we are very keen to engage with trainees to offer opportunities to you and to support you in what we know are sometimes very difficult times. And, you know, keep your eyes on what we're doing at the Edinburgh College because a lot more support is coming down the pipeline for surgeons in the next 12 months or so. Um, which is keeping you awake at night? Can we go back to the slides, please? Guys, click angrily. Will things happen? Mhm. Yeah, somebody's got their hand up like a surgeon might be capable of being patient. There we go, Right, right. So we're gonna talk a little bit about research because it's the other element of a CV that you'll need to to be considering when it comes to consultant jobs. Is there anybody in this room who sat in an a r c p and not be told that they need to do more research. Anybody had that experience that they've not been told to do more. I mean, it's just not a thing, is it Every a ercp you go to Oh, you need to publish more. Or have you finished that paper, didn't it? You know so So researches is ever present. And I guess we've got to think about Well, in what way do we want to engage with research to surgeons? What sort of a surgical scientist should we each be? And for some of some of us and some of my colleagues that maybe that you should just have the skills to interpret papers and interpret the research that is given to us. And if only our deer government had the same skills? Wow. Would we have had a different pandemic? Um, but for some of us, we do want to take the boundaries of science or education and training forward by producing new and innovative work. And research is really for us, and we need to be looking at having a research portfolio. So for C. C. T. It is a requirement that you are research engaged in research active, and there are targets that you have to meet and you will be well versed in those and you'll be reviewing them at every RCP that you have. So how are you going to actually win at research? You must publish Great, but we know it's not easy. So how are you actually going to get those publications over the line? The first piece of advice I have to. There's somebody who's had multiple research projects of which have founded, some of which have flown is to work with the team as a one man band. You and your laptop in your bedroom. It's so not a thing. It's it's you're just not going to get that research over the line as much as anything. The majority of your in six months rotational posts. You might be lucky enough to be in a hospital for 12 months, but most of the time you're moving on every six months. By the time you've got ethical approval to do anything or the pile of notes has finally landed on your desk, you're moving on, so you need to ensure that you've got a team working with you and think outside of the box regards to who could make up that team. It doesn't just have to be doctors. There are many other members of staff who are more permanent than you are who could perform a part of your team and who are also looking for publications. You need to identify your target journal before you start collecting any data or writing anything at all. Yeah, journals have particular areas of influence particular areas that they're going to take publications and do not write a speculative paper and then see who you could tout it out to. That's not a winning formula. I do. A lot of reviewing for journals drives me nuts when it's just like this is so not our field. Why am I having to read this stuff? You need to choose a supervisor, make sure that there's somebody there who will set you targets who will make sure that you're on track. Make sure you're not barking up the wrong tree. I need to set yourself very tight deadlines, achievable deadlines and set time aside to achieve those deadlines. You know, Friday afternoon I'm not doing any clinical work, so I'm going to get my haircut and then I'm going to sit down and finish off that section of my research project. I'm gonna write the method section. I'm going to check out the abstract I need to publish. Eek! It's difficult bit. So what other reviewers looking for? And this is me sometimes with a glass of wine on a night. Kids are in bed looking through your paper. So what am I looking for? I want to make sure that your that your publication is scientifically sound, that the design of your research actually suits the hypothesis that you're proposing. If if you if the paper doesn't make scientific sense, I'm going to start reading really quickly and move on to something else. We then check is your work original. And we do use Dr Google to help us with this. It costs you nothing to do, Doctor Google before the paper lands on my desk when I'm slightly grumpy at eight o'clock at night. So check out is, are there a lot of other publications in this field? If it is a field that's been well published in previously, how well do people do after knee replacement, for example, you need to make it really clear in your abstract. What is your USP Why should we publish your paper when they're already 20 papers in our journal on Why Knee replacements do amazingly so make sure that you've got something that shows that you're advancing knowledge and that it's something different. Make sure that your paper matches what our audience wants to read. So if you've got a paper on, um, Patient's who are sad, need more hand therapy to get over to PT ETA Meas Don't send it to the American Journal of Hand Surgery because actually, the hand therapists want to read that the surgeons really aren't that interested, but the hand therapist will want to read it and you'll be straight into a hand therapy journal. You won't get into a major scientific hand journal, so check your target audience really carefully and we're all in, you know, particularly you're a research track trainee and you're wanting to head 22 clinical scientist professorship post. In the future, you will be very aerated about impact factor. But realistically, an orthopedic publications impact factors are going to be low. You're not going to get your elbow fracture paper into the Lancet. That's just not a thing, is it? Yeah, but you will get a good audience if you put it into the Journal of Shoulder and Elbow Surgery. So put it into the correct journal for what the paper is talking about. We're hoping that the surgical training journals are going to become increasingly impactful as more people read them as more people quote them as surgical training becomes more of a thing that's more generic. Where you're affecting more specialties, you'll get a larger audience. But for the majority of our publications, they are by definition, going to be niche. So please send them to the niche journals rather than heading above the level. Make sure the papers clear. Um, you know, if if writing clear English isn't your thing, ask a friend and they don't necessarily need to be a doctor friend to just check that your paper makes sense that it reads well because journal editors will help with minor grammatical corrections. They'll help with minor spanning corrections, that sort of thing. But they won't completely restructure every sentence you've written because it's it comes out in gobbledygook. So please make sure that you you right well, and ask people to help you, right? Well, if it's something you struggle with anybody Have any idea what the J. B. J s acceptance rate is? So let's start by a show of hands. 100%. Who thinks 100% of papers were accepted by the J P Js? All right, 8%. 50%. Some people think 50% like your optimism. 30% A few hands there. Yeah, 15%. Yeah. So a my aim appropriately, you know, you're not going to get all of your papers and the J B. G s. Your boss might push you to it. But don't waste your time on the on the to and fro of major corrections, it goes back, it gets rejected again. Put it into a journal that it's suited to, and you will get published. For those of you that's a research track or really wanting to show your research, correct credentials know how strong interest in research. We've got another alphabet soup and there are a variety of research higher degrees that you can undertake the mg and the PhD where you're taking time out of your training taught courses, um, or online courses. And they all have their different merits and different tracks will suit different people, and you should read up the information and make a decision as to where you want to go. If you are looking at a higher degree if you're looking, if you're very ambitious and you're wanting to be an international researcher, if you can see a future where you're going to be a chair of orthopedics in the hospital and you're going to have an international career, I'm afraid the only deal in town is a PhD because the majority of the world qualifies as empty so it doesn't get recognized. So if you're really wanting to do that thing, PhD is the way forward. And PhDs can be great fun. Mine was a who we can help with funding. The Edinburgh College has a generous amount of funding for research, and we're very keen to foster good research and to encourage good researchers once again the orthopedic designated research funds. So we have some that are designated for anybody Any researcher can apply, but we also have specific funding streams for orthopedics. The orthopedic funding streams are not well applied to, and the majority of the applications that we get come from those terribly clever transplant surgeons. So can we please have some more really clever orthopedic surgeons applying for the research funding? Because actually, your your applications when we see them, they provoke great interest with the research and awards committee and and are often very successful. So we are able to fund entry level funding for MDS PhDs and to help you get your your research off the ground. The college is also very interested in innovation, and James clearly has some views on robotics. As a hand surgeon. When I'm a very haptic surgeon, I can't forever for see me being involved in robotic surgery. But the college has convened a working group, working across all the surgical specialties, looking at robotics, and we're now a national center for robotic surgery. So if you're interested in pushing the boundaries of robotic surgery forward and to be fair, the majority of the fellowship applications were receiving at the moment are people wanting to do robotic surgery fellowship. So it's clearly something that your generation are very engaged with. Please look at the facilities that we have at the Edinburgh College. We have a few DaVinci robots now, a lot of funding and some very engaged faculty to take forward robotic training. And here we've We've tried to suggest a way in which robotic surgery can be safely introduced into a new unit because there are lots of units, there are lots of healthcare providers, Shall we say, if we're being diplomatically who are buying robots because it makes great advertisements? Please come to our healthcare provider. You can see an expert surgeon next day and he'll operate on you with the robot. We've only just bought it. He doesn't know how it works, but you operate on you with a robot. I mean, it sounds great, doesn't it? So we're trying to suggest safe ways of introducing these innovations into practice in terms of developing your skills as a communicator. We all did communication skills training at medical school, and then it kind of stops, doesn't it? Because it's kind of expected that by the time you've graduated, you're really great communicator. But as surgeons, we have to communicate on a cul different level with a whole degree of medical legal complexity about it, and we get no further training in that in general. So one of our College council members, Jan it Wilson who is a fearsome ENT surgeon, has developed the icons course to help and support you, and certainly for senior trainees and those going into early years. Consultant practice, I can't recommend this course highly enough about how how to communicate with patient's, how consulted, how consenting is not a sign of consent form. It isn't a thing that the junior doctor does on your behalf. It is a process of developing a shared understanding with your patient's, and if you develop a shared understanding with your patient's, it will keep you out. Of course, one of my trainers who influenced me the most was Bridget Scammell. I don't know how many of you know her. She's the first female chair of orthopedics in the UK Brilliant lady. She's a foot and ankle surgeon. She specializes in treating rheumatoid and diabetic feet. So you can imagine bless her. The results are a bit poor. You could say some of them are really shocking. At the time I worked for her, she'd been imposed for about 15 years. In all that time, she had not received a single complaint from a patient. Why, Because her clinics always overran because she spoke with her patient's and developed a shared understanding of what the problem was and how to move forward. And this course will help you become more Brigid and hopefully stay out of trouble. I try every day to Bridget, so there are ways in which we can help you become a better communicator. As I hope we've managed to sort of instill in you today. There are many aspects of being a surgeon that are not well covered in your training. I SCP covers basically the technical stuff, and that's the stuff that you get judged on every time you go to an A r C e p o. I must do more of this. I must be more. I must be more confident. We all love that one. Don't think that's a great chestnut from from our ERCPs, but actually for being a surgeon at your stage, at my stage at retirement stage, there is so much more to doing the job. There is so much more to being safe in the job, and there's so much more to getting enjoyment, fulfillment and happiness out of the job because, let's face it, for the majority of us, most of our working hour of our waking hours are spent either being a surgeon or thinking about being a surgeon. It's such a big part of our identities. We need to get the most out of that identity and use all the facets of our personalities. And within this room, you've all got very different personalities, different attributes, different abilities. We need to nurture those and bring them into the workplace. Give them formal names. If we must like, I'm going to be the great trainer. I'm going to be a great scientist. I'm gonna be a great communicator. But actually, we all need to have some of those facets of ourselves and bring them forward. So I'd like to open up to questions. Hopefully, we stimulated some good questions and that our panel are available to you. If you haven't registered on the chat, please do just so we can share all the questions with everybody and I'll start reading some of them. I think we have around 8, 10 minutes for questions, so we'll go through through a few of them. So one question here, um, for Harran, our health board doesn't have any recycling separate facilities. How would you advise approaching them to change this? Yeah. Team based approach is obviously important. So you need to get the leadership within your department on board. Maybe start with the presentation. Sometimes just for me. It was hearing some of these, um, sort of very astonishing numbers if you just give a presentation and then encourage them, you know? So there are other trusts do a bit of homework. There are other trusts that are doing this, and we need to get on this. It's the direction of travel around the country, and we don't want to be left behind with it. But awareness and education is the first step, and it's shortly followed by Axion. Thank you. A question for James. Is there scope for senior registrars to become clinical supervisors to foundation trainees? And how can we support this cohort to do so? Yeah, uh, there's two answers to that question. The answer is, is it a reasonable concept is yes. Um, there are very strict rules. So if most of the colleges and I don't know who actually oversees it for foundation doctors, but certainly for C T and S T trainees, there are very clear, hard red lines about who can and can't supervise. And I suspect there probably is for foundation doctors as well. But I don't know where you would find that information, but that will be the key of what is and isn't acceptable from the G. M. C or H E. I don't know if anyone in the audience knows that information or either of my two colleagues up here. Mm. I suspect that you have. Yeah, probably the GM. See, I suspect it's consultant only is my hunch, but hopefully that might change. I think it's a very fair point. Uh, staying on the topic of G m C g m C. Standard state teaching is part of a consultant junior contract. Should those not interested to do any teaching do more clinical work? Yeah. Controversial? Maybe. Um, I think you make a really good point. And, you know, I like James. I feel slightly embarrassed sitting in front of a group of trainees when we've got a load of read outliers on the G M C survey. Um, and we do have trainers who have openly said that they're not interested in training. They're not going to let the juniors hold the knife, but they still want their presence in the outpatient clinic to see their follow up patients'. And I think we need to be more ballsy about saying to these individuals that actually, yes, you can you can do the clinical gruntwork if that's what floats your boat You did the clinical grunt work and we'll have the fun of looking after the trainees. Um, so I think we we do need to be stricter on that, Um, but in terms of the remuneration that's given for training, it's very low. So the average consultant job plan in our trust will only be given no 0.25 pas for training, Um, which basically covers their duties to the medical school when the medical students come and join us, and maybe being a clinical supervisor to one training only, just particularly M. C R. It doesn't really cover the amount of time that they put in just for a very basic level of engagement. So until training is better, renew berated and better enumeration within job plans, Um, it's difficult to use time as a stick with which to be poor trainers. Unfortunately, thank you. Another question for gyms here. What are your thoughts on Prell? EPT. Ick appointments to support new consultants. On what? Sorry. I know I had to actually Google it. Um, I have to admit protective appointments. Okay, um, this is a really I think it's a really tricky issue, that part of the challenge of having just gone through trying to generate post for a new consultant. It's all about money, and it's all about. Unfortunately, NHS works in a financial year, two financial year in most places. So it's very much this money is available in this financial year for a new post. If you do not appoint someone in this financial year, this money will disappear. And in the next financial year we'll revisit whether they're still a post or not, and and the other counts, that is. I know, certainly in our region, they've been appointments where people have been told ahead of time will appoint you. You can go on your overseas fellowship. And then halfway through the Overseas Fellowship, they've said, Oh, actually is quite good here, and I've been offered a job. So I'm resigning and not even taking up the post. And there's a huge amount of time and effort involved in appointing a consultant a huge amount of time and effort from people at a very high level. And so I think more and more trusts are very much. We're only going to a point when it's clear someone's going to start in the near future, and they really are going to start. They're not going to let us down because they've had their fingers burnt. Okay, um, for the purpose of time, we'll take two more questions and then we'll stop for tea and coffee. Uh, one question. Back to Harun on sustainability. Obviously, we say raising awareness is important. However, some people say, As a trainee, it often feels like you have very little say in the choices of implant gloves, single use kit. It's just very hard to open the conversation besides just raising the awareness. Anything else that the trainee could do? Just get that it's not just trainees that take an interest in this, Um, I think if you'd be surprised if you actually addressed the department, how many consultants are interested in this? And it's about working collaboratively, So it's about identifying that other, um, sort of staff that are that have an interest and can collaborate with uses. But again, it's just about a team based approach. I do appreciate some units are difficult to deal with, and, you know, sometimes it's hard to break through what's traditional, but you've got to start somewhere. Um, I think it be hard to address that question without knowing the specific failings. I mean, I would start by insisting on a presentation at a big meeting that the Eminem, the Grand Ground, the M D T. Maybe all three, and you will find people that take an interest in in it and will help you take it forward. Some of these measures are very straightforward, like recycling is actually quite a straightforward thing to do. It's not a major change. Um, you know, um, dis using instead of using disposable caps using reusable caps, it's a very easy thing to introduce low cost. We do have some reusable surgical caps to sell from both just I'm going to plug that in right here. Yeah, exactly as you know. Yeah, I was just going to be very subversive and suggest that actually, if you're struggling to green your theater, you need to get the nursing team involved because actually, they have. The biggest thing is to what gowns are put on the shelves in your theater scrub room. They're they're the ones that go and find the gloves. They're the ones that sort out the bins and the rubbish stream. So, actually, if you get them involved and you will, it's rare that you're in an operating theater with somebody who isn't keen on becoming an EEG champion and wants to take this forward. Um, they're very engaged and and they're aware of it through to through their their professional groups as well. So use the nursing staff. We we we do tend to be very doctor focused. Doctors aren't the answer to everything. Our nursing colleagues are there to help us and we can work with. And one last question before tea and coffee in relation to the I. C P function. Looking at the trainers, can trainers only use the trainer feedback function for trainees that they represent as an educational or clinical supervisor or any consultant registered on ICP involved in training can get feedback using this as any consultant who is on SCP as a trainer and you can send it to any trainee who is registered on I s C. P. And there is a not applicable option. So some of the questions are around educational supervision as an A s. But if if you haven't done that role, they can just take, not applicable and fill in the bits that are relevant. So as long as the two people are registered, it works. Thank you. Thanks again. For all the three speakers from the Royal College, a week round of