Computer generated transcript

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

Next, we have Jonathan Russ, um, who is a registrar, um, currently working in Colorectal surgery. He's gonna be just on that. I'm just going to invite him onto the stage. Oh, lovely. Lead me to it and I apologize if I butchered your role. Uh, I know we've never met. Can you hear me? Ok. Um, II can hear you perfectly. Are you able to share your slides at all? Yes. Yes. Uh, perfect. Let me know if you can see them, I can see your screen share at present that's working out. All right. Yeah, I can see your powerpoint now. Perfect. Once you sh oh, lovely. You beat me to it. Didn't have to. Brilliant. Ok. That's perfect. Thank you. Thanks, Jo. So I'm Johnny. Um, I'm ast five in colorectal surgery and general surgery at the moment. I, at the northeast of England. I am freshly, er, back off a flight from Canada, a night flight. I got, I landed two hours ago at Heathrow. So sorry if I look, uh, pretty tired at the moment. Um, so I'm here to talk to you about colorectal surgery. I've sort of got the easy end of this because, uh, I've got the bottom end of the, er, literally, of the gi, of general surgery and the gi tract. So the guys have already spoken to you quite a lot about what general surgery is essentially already, which is quite nice. So, um, to recap that to some degree, um, so essentially, uh, colorectal surgery is a branch of general surgery. There was a really nice, er, demonstration of the sort of branches of general surgery and the pathway you take on the previous presentation. Um, and so generally around the ST five level, you sort of sub declare, uh, you declare what your subspecialty is going to be out of the various eight or nine that there are um, and essentially colorectal surgery and then eeg S which is emergency general surgery is one of those. Um, so your colorectal surgery work essentially is made up of three different aspects. So, your elective work, which is you sort of some of your general stuff. So, so some, er, colorectal surgeons are doing cholecystectomies regularly, your hernia repairs, abdominal wall repairs, er, you have your colorectal specific bits, your colectomies, your stoma formation, um, stoma reversals, proctology bits, which is the bit that often most colorectal surgeons like the least fondly enough, er, which is your hemorrhoids, the fistulas, pilonidal sinuses, that sort of thing. Er, and then in colorectal you do pursue an endoscopy interest. So you do colonoscopy training. Um, and there is quite a large portion of people who do the colonoscopy training, er, and then move on to do some of the, er O GD training afterwards. Um, if they can get through it with their JA accreditation and time or at least they do in the northeast. Um, any general surgeon or most general surgeons, with the exception of breast and some of the set ups in H PP er, and transplant will do an emergency sort of on call system, sort of acute abdomens, er, ischemia perforation, your laparotomies, major trauma, if you were in a major trauma center, er, your gi bleed and that sort of thing. Um and then your extra bits that you take on as part of your general surgery role. So some of this is is sort of consultant level and some of it you can pursue as a registrar, an sho so your educational bits. So that can be anywhere from having a role at university in medical education to you sort of being TBD for core trainees, having an educational role at registrar level, educational supervisor, clinical supervisor. Um all the way up to being things like a proctor on a robot for other consultants are running sort of courses that are really particularly subspecialists that will have a consultant audience. Um and then there's a big push for colorectal surgeons to be colonoscopy trainers, at least in the northeast of England. There are er because there's a bit of a lack of that and then in terms of your private work as a colorectal surgeon, there's not a lot of private work as a colorectal surgeon. But what there is is a lot of private work for colonoscopy and relatively rewarding. So, um if that's something that you're interested in, not particularly for me. And obviously in the northeast, there's not a huge push for for private work. But um colonoscopy is AAA thing you can pursue it from that. Um in terms of the work that you do. So, the main thing that drew me to colorectal surgery was the resectional work and the cancer work, which I'll talk about a bit more later. Um pretty variant. And the thing that a colorectal surgeon will pride themselves on is they work around the rectum and in the pelvis. So there are things like low anterior, high anterior, which are the top two on the left. Uh And then your APR S which is your bottom left, um are really, really sort of rewarding operations and tricky stressful operations at times. Um And they make you really feel like quite a complete colorectal surgeon. To be honest, then you have your more generic segmental collections, which are the ones I've mentioned. But there's quite a lot of different ones, all follow similar principles, but with different caveats and things to look out for um in terms of colorectal surgery. So it's quite good, especially in terms of the range of methods that you use I did initially have a picture of a laparotomy on here but I thought it was a bit too, er, gory early on to put on. Um, but essentially people are still doing open operations, people are doing laparoscopic operations, which is what this image demonstrates. And then the robot in colorectal surgery is probably the biggest, er, one that's used in general surgery. I'd say in terms of subspecialty add on it, there's in my opinion, or at least in my region. And from what I hear around, there's no other subspecialty in general surgery that's using the more robot, more than the colorectal surgeons are at least not as widespread. Um, so there's places for open operations, still places for lap and places for robotic stuff. So it's quite good in terms of keeping that core skill set up. Um, in terms of what you do do today, I thought I'd sort of run through two different days. So one is my elective day and one is my emergency day. I'm not gonna read through the entire slides, but I think just things to highlight. So if you look at the emergency or the elective stuff first, sorry. Um, the morning can be quite hectic, to be honest with you. So you, you, you, most of the time, depending on the center that you work in, you meet in consenting patients who want theaters as well as trying to ward round on the patients that you've got on the ward or before. Sometimes your theater starts half day in fee to say if that was the case, you can do anything from a lap. Right. Hemi, that you might do with an sho or a consultant. He might do some re hernia repairs and a lap Cawley. You might do an AOS toy closure, a lap call. They've been the last three half day lists that I've had as a registrar. Um, then you'll have a bit of time for lunch. You might have to go to clinic. You check in with the ward team, make sure everything is ok on the ward or I do at least with the F ones, uh, before you go home and then you'll go home and that's generally a pretty good day. Go home on time. I get home to my, uh, wife and dog and, uh, have a pretty nice evening most of the time. Now, the emergency stuff's a lot more hectic. To be honest with you, your emergency stuff's really variable. It's really variable depending on both your unit and day to day work. To be honest with you. Um, so day to day, you're generally doing eight till eight shift or eight till 830 shift or eight till nine shift. Um, depending on what hospital you work in. Um, but essentially you do the day start similarly to handover with ward round the, uh, for things like lap appendix, obstructive inguinal hernias, uh, aes for small bowel obstructions whenever you're in theater and you're on call, you have a whole host of VD referrals and board referrals that you need to catch up with. You need to catch up with the ward team, which is often what time spent doing? You get urgent calls to A&E for people who are very unwell that you have to organize emergency laparotomies for which are often quite difficult discussions based on their mortality and the morbidity that they often carry, but equally can be really satisfying work when they go. Well, um, but I think the main thing to sort of catch from this is that there's, the emergency work is busy. You'll generally do three or four days of them at a time and they are tiring. Um Sometimes you sort of really trying to squeeze in food, trying to squeeze in a bit of a break and stuff. O often you have days that are really chill and you'll have a couple of hours break and you'll not, but more often than not, they're pretty tiring days to be honest with you. So I think the elective days are really good, um, but still quite full, but the emergency work is, is quite tiring as a registrar anyway, in terms of future of the specialty. So I think everyone's pointed about various things here, but they all have a common theme. The robot is coming for general surgery and is there for a lot of colorectal surgeons already. Um, so in my region I've done uh a resection on the robot, I've done, I've been doing regular uh hernia repairs on the robot through some really good trainers at the center of that moment at the moment. Um, we have a sort of set system of the registrars doing some training at the, er, at the sort of training center that the robot's based at, in the region. Um, and so actually it, it's pretty accessible and I think that's coming, especially for, for colorectal surgery. I think most places in the northeast, in fact, every place in the northeast except one hospital now has a, a robot. Um, at least one often two. So they're used pretty, pretty widely to be honest with you. And so the trainees are really getting their hands on a peer on them and it's amazing to actually do it, to be honest with you. It, it, it is like there's a lot of yes or no on the robot but it, when you have a, when you actually operate on it, it's fantastic. Um A II think has already been mentioned uh by both or G and HPV. But essentially it, it, it's coming definitely within my lifetime, I would suppose it's gonna have a role in health care. One of my colleagues in the region has done a really good phd about A I interface over colonoscopy and he thinks that it's gonna apply to robotic and laparoscopic stuff as well. So essentially it's gonna in endoscopy at the moment. Essentially, what it does is highlight polyps, highlight areas of interest, highlight areas of abnormality, the feed to take an extra look at. Um what they think it's going to do on the robot is essentially be able to map anatomy, map areas of danger, map areas of interest. Um tell you essentially where planes are, which is going to revolutionize train. Um So I think A I is coming and I think with A I comes a bit of VR stuff. So I think the robot's equally brought that in. So to train on the robot, you've got to do the simulation modules um which are essentially sort of stacking cubes on a simulator using the robot. Um and now it's sort of bits and bobs and some suturing and things that where lap stuff will go when people are training. Um and I think it will with colonoscopy as well. So there's, there's some uh VR colonoscopy trainers coming out as well, which is really interesting. So I think that is the future of training. Um interestingly just quickly in terms of the future of colorectal, I think generally people will look back at all cancers er and see us chopping them out as being completely barbaric, to be honest with you in 100 years time, similar to when we used to chop legs off for infection and things, I think it'll be looked back at as absolutely mad and I think eventually they'll come up with some sort of gene therapy immunotherapy that will treat people essentially through gene mapping. Um So how do you get there? However, you get to whatever ST eight in colorectal eventually. So, again, this, I think this has already been touched on quite well. So I think probably what I'll do is more just apply my own um, spin on things and what my route was. So, er, I went direct to UNI from sixth form. Er, I did, I went to Newcastle Uni, I did foundation up at Sunderland, which is in the northeast. Um I finished uni wanting to be a GP er, or do PS one of the two, which is a bit of a ro one in comparison to what I am now. Um And then I changed based on a foundation job that I did in F one and I really enjoyed the consultant body. The registrars were great, the Sh Os were great and I just found a, a sort of tribe of people that I really got on with and really uh had a lot in common with and really enjoyed the work they were doing. Um And so that completely changed what my life plan was essentially. Um And I think the big thing that, that highlighted for me is to find a mentor early on to be honest with you and find what you're really interested in. Don't sort of pigeonhole yourself early on, which is what I had done up until that point. Um, and then, because I didn't really have a lot of surgical experience cos I was sort of late to the game of wanting to get involved. Um, I did take an F three year where I was a teaching fellow, er, in H BB in Liverpool, which was a fantastic year. To be honest with you, I'd recommend that to anybody who's thinking about it. Probably one of my best years of training. Um and it really helped me hit the ground running for course surgical training, which I did back in the northeast. Um I think the thing to figure off for course surgical training is you need to get your portfolio ready, which people have already mentioned, you need to get your exams, which people have already mentioned, try and do early. Um But the big thing is you're sort of learning how to manage the on call a little bit and how to operate a little bit. Um and other things you sort of take out called surgical training or at least add. Um And then in CT two had a really good year with a really good mentor at a place called North Tees um hospital. And that was basically what persuaded me to do colorectal in a lot of ways, um really inspiring work, a fantastic surgeon and trainer when I was there, er, and similar with the Registrar body. They were, they were fantastic. So I learned a lot, had a lot of interest, sort of ignited my passion for what I wanted to do. And the reasons for me, essentially the reason for choosing colorectal. So I definitely wanted to do gi surgery. I really enjoyed the H PB time I did at the end of time doing all g resectional work as a registrar. I really, really enjoyed that. I loved it. Um But for me, I'm not the most academic person and II am someone who wants a bit of work life balance and for me to do cancer work. Um and do RG or HEB, I was gonna have to do a phd or at least an MD and it was gonna really be quite a big commitment work life balance wise. And I just wasn't for me, colorectal offered the cancer work without the academic requirement necessarily and a bit more work life balance. And so that, that was sort of what edged me towards it, but to be honest with, I think I would be having pretty much any, any gi surgery to be completely honest with you. Um So I think the thing to think about as well is when you get to consultancy, you can tailor your job plan somewhat so you can get involved in education. Like I've mentioned, you can get involved in management, you can get involved in a few different bits and Bobs. So I think, try and sort of identify what things you enjoy within higher surgical training, within your registrar years. Um And then you can sort of think about how you can tailor things and, and what you sort of want your consultant career to look like. Essentially. Um the big question I always had at this stage, I remember when I was going to assay conferences and, and talking to people is what can I do now to help you get there cos that was what I was worried about. And I think people, you speak to people and the people who are really loud about things have got loads and loads of stuff. And that used to stress me out a little bit, to be honest with you. And there was a guy called Ed Evans who's a consultant up in the northeast now who really had a talk uh that I went to, that was really sensible and essentially he was just saying, usually time really well, you don't need to do all these things individually. So there's all these things that come up when you try and get you, when you, when you Google, what John showed you when you Google about course surgical training and higher surgical training. Um And I think the things you, you want to build up a core of what you, what you do first. So you've got the improvement stuff for your audited stuff, some teaching and some presentations and essentially that can all be one project. So you can, what I did for mine was, I did a teaching program on ENT, I did some feedback forms beforehand about how confident they were with Ent and then did some feedback forms afterwards about how confident they were for ENT demonstrated that people could be much happier. The majority of people finishing uni are gonna be GPS, 20% of GP er consultations at ENT. And so I basically showed that you could improve people's understanding of a NT pretty quickly, pretty easily. I presented that. Um, and so through that I got audited, I got a teaching program and I got a presentation through, through one piece of work. So I think you just have to be smart essentially with the work that you do. I also think within that there's certain things you need to be doing to make sure that you're gonna choose the right thing for you, the right sort of career and the right subspecialty. So pe to weeks, I did mine in pediatric surgery at the time, which I really enjoyed, but I realized the lifestyle when I was chatting to the registrars and the consultants wasn't for me. You need to get some theater experience, don't do surgery, cos you think it'll be cool and it's good to tell your mates about. Um, you really need to be in theater, make sure you're happy in the environment, happy, doing practical stuff. There's a lot of talk about people saying that they don't learn practical skills well. And someone once told me, you can always teach people how to operate with enough time. Um And actually a lot of it, the clinical decision making is the tricky of it. So, and that reassured me quite a lot cos I always felt like I wasn't someone who picked up practical skills quite as fast as what some other people did. Um And then courses and conferences, conferences, more of your own interest. It's great networking as it was really good. II remember going as an F two, I think I was um and I went as an F three, it was great and I actually networking, you see people that you, you sort of semi know from various courses and things and then courses wise, I think ATL S is really good to do early on, to be honest with you. And then I think basic surgical skills is really good to do early on. I did both of those and F two and it gave me a bit of a head start hit and course surgical training. Um And then the bits that are left to your publications and your research are quite time intensive. To be honest with you, quite a lot of input, quite a lot of sometimes money for publications um and PG cert wise and extra degrees. So I think focus on the core things that we've highlighted, focus on the bits that you wanna make sure this is the right career for you and I think you should get with the new core surgical stuff. Um, so things that I asked regularly, have I done a high degree? No. And I, I've got APG cert, but I'm probably got no interest in doing an MD or a phd. Um, although I have pursued looking at one just to make sure I didn't want to do that. Um, I've actually not really got any publications, I've got a one I think. Um but it's not great. So that's currently in the, but you don't need publications to get here is what my point is, but you do need them for CCT. So you do have to do them at some point um in terms of my life outside of work. Um So my uh wife is not a doctor or medical in any way, none of my friends are, I play a sport twice a week. Um And uh I've got a lot of interest outside of work, so I still have a lot of time for sort of work life balance um and seeing friends and managing that. And I think sometimes when you're with a lot of people who are nonmedical, the demands of the on call and the, the demands of the job are somewhat poorly or a bit less understood sometimes cos you do a lot of work in your own time. And so I think um allowed me to sort of have that really good balance, to be honest with you. Uh, I be due to do general surgery again. I think I've got to work most days pretty keen to get involved. I'm just back from Canada for two week. Uh, and I'm, I've already checked what I'm gonna be doing next week. Um, and I've been there some days and it's already looked excited and I was quite happy looking at me, don't it? There's many people who will come back on holiday and look forward to getting back to work, but I do essentially and I think a lot of general surgeons do. Um, so thank you. Uh, oh, that's been pretty, it's been pretty quick because I think it, more of the general surgery bits have already been covered probably in a bit more depth. Thank you so much for taking the time. Um, yeah, so, well.