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Good. Okay, good morning. Good afternoon. Good evening, everyone. Uh Welcome to uh Gastro General Club today, the 20th January. And we are on an anesthetic focus today and I will introduce the paper and our esteemed speakers very soon. But before I do that, just to welcome, uh firstly, I'll introduce myself. Uh I am right now is I'm anesthesiologist from the UK, but currently working in Uganda and I am Vicepresidente Gas are going be hosting this session today, just me and, and do some the tech behind the scenes. You may see some interactions are Presidente Monahan, please, who's also working again previously, but is currently uh in U K. Welcome to the people are present today. Um Please put any questions you have in the chat as we go along and we'll have discussion at the end as well. It's really pleasure to have you with us also. Hello to anyone who's watching this online as well later, just before we start, I just at the beginning and we'll mention it again at the end. Another event that's coming up on the second of February is our frugal innovations courses. A launch date on the second of February and we shall put an advert up in the chattel maybe at the end just to see the sign up for that. But that's going to be a educational course looking at range of innovation and research skills for, for any of the specialties, any Canada's can be involved with that and more information can be seen on our website or our social. So have a look out for that that's coming up later on. But let's go on now to the main event for today. Okay. So before we start, I'd like to introduce our speakers, which I have the pleasure to introduce you joining us today from India. So firstly, can I introduce Doctor Guiton? Uh She is a consultant, anesthesiologist and intensive care. Excellent anesthesia associates from hired about rainbows Children, hospital, birth, fried. Uh previous positions held include Professor of Anesthesia uh CMC hospital, the law in India, as well as consultant anesthetics at Addenbrooke's Hospital. Areas of interest and expertise include pediatric and obstetric anesthesia. So as regional seizure difficult airway management, ultrasound and ask you some intensive care and importantly for this topic and that will be discussing it has been involved as an instructor in many courses, as well as a modular vegetative edit er for P A CT and a vast country coordinator. Vast is another type of short course X Presidente of I S A Hyderabad and ex president's IAP A 10 Agana State. So thank you. Don't get enough for joining us. Very welcome. Also the pleasure Dr Slater who is also a consultant, uh anesthesiologist at Rainbow Children's Hospital areas. Interest again, importantly, simulation, maternal and pediatric and Hirase obstetric intensive care achievements include a member of the Indian Society of Anesthesiologists Hyderabad City branch treasurer of the Indian Association of Pediatric anesthesiologist had journal publications on simulation and offer chapter on CPR updates in pediatrics and a faculty for the World Federation for Safe Anesthesia Pediatric Anesthesia. As well as many short course involvements include in the vast vital and seizure simulation training and high risk and pediatric workshops. And I have participate very happily participated in short courses with both representative day and I can say that they are very much uh well well versed in this topic, which is appropriate for our paper today, which is the priorities for content for short course and post operative care relevant for low and middle income countries and E Delfay process with training facilitators. Now, postoperative carers had much more attention, much deserves attention has previously. So this topic is very timely and appropriate and important for consideration. So it's very, very welcome to have some uh to present today. Speak to us about this paper about post operative care. So after overdue, I'll hand over to doctor Salida who's going to present the topic and the paper. Follow doctor get an apple, add some comments and then we'll open it up for discussion. So doctor Leader that forever. Do please? Thank you uh gone for the uh introduction and hello everyone. Good day to you all. Uh Let me start off by share ing my screen. Mm uh Is my screen shown. Yes. So in sync, you can see it. Uh So as introduced, I'm doctor Sharjah Comma Batalla from Rainbow Children's Hospital Hyderabad. And we are located in India and uh I and Doctor Gitana are part of this uh study that was done uh in the previous year. And uh uh this is about the priorities for content for a short course and post operative care and relevant for low and middle income countries. Uh It's a needle fee process uh with training facilitators. I and Doctor Gitana have been part of WFC, see courses for a long time now. And we have trained many participants so far. And uh so we were included in this uh study as part of WFC uh facilitators. Uh So we have uh our study was published in Anesthesia Journal uh in 2022 these are the other authors with us. So I'll be dealing with this topic under these uh subheadings. So what is it that prompted uh for the for this study to take place in the first place? Uh It is because there are a lot of short courses available uh right now which have been done uh since quite some time like the WFS, a safe courses which are basically uh important and take uh into focus the pediatric and obstetric anesthesia. And uh these courses have been going on for quite a while and they have been analyzed like regarding how the participants are benefiting from them. So there is a lot of improvement of skills and the confidence in the team work abilities of the participants. Uh This all has been observed because of the analysis and we think more and more short courses should come up for different critical uh events or different critical areas of work in our field. And there are also other courses, multidisciplinary course on operating room, room care and basic low resource courses. All these courses have a little bit of post operative care uh in, in them. But uh the whole of it um like very comprehensively, it has not covered, I would say. So that is the reason it was taken up as a study. And uh we started working on this. So it was aimed to collaborate with established safe course facilitators for from low and middle income countries to define the key components. What can be the items that will be taught under proposed short, post, post operative care for uh post operative care and complications, short course and uh the teaching form as the participants, the facilitators who will be and how it will be done. Everything uh was discussed in detail along the process and uh specific course content created. So the objective of uh this study was to develop a short post for postoperative care of the patient's. So, coming to the materials and methods, ethical approval was obtained from the Oxford Tropical Research Ethics Committee. And uh this uh study was done by a Delfay process which is a systematic method to determine agreement on topic through consecutive interactive sessions. We had a multiple Delphi process is uh from different geographical areas and it was done in English, Spanish and French languages and multiple languages. And all the rounds were attended by a panel of experts from WFC of course, facilitators and they remained anonymous so that proper processing is done. So to those who are new to the Delphi process, uh it is an organized method for collecting news and information pretending to a specific area which in our case worth to check on what items can be included for a short course for POSTOP, post operative care er and uh complications or in the POSTOP. And uh this uh involved involving all the different uh experts from different geographical areas and a lot of information was gathered through different processes and uh assessment was done. Evaluation was done. And finally, we came up with what can be, what is act for the short course. So other items included in this process in this Delfay process, we're uh items related to the content for a potential short course and post of care and complications and the teaching methods, participants and the faculty. So uh these are the different geographical areas from where the experts are putting their inputs uh w faces if uh of course, facilitators are all over the world. And uh around 8 68 anesthetists were invited initially when the study actually started from 45 countries. And then finally, 86 of those experts responded. And uh so they belonged to these different four regions. And it was initially decided that if a region has less than 10 panelists, then that region would be included with another region. So Western Pacific region here was included with Southeast Asian region. The modified Delphi process was used here. The exact process of uh Delphi is actually little uh changeable and no exact process is well defined for it. And modifications have been done previously also. Uh So in our case, we wanted to reach out to a larger group of experts and uh decrease the carbon footprint and uh derive a global perspective to this study. So it was done fully online and eligible participants also joined in any of the Delphi Ron's. We had three Delphi rounds going on. So uh participants could join in any of the three rounds that uh was uh good thing done because there is a lot of fallout. And addition, also that keeps happening. And uh the Delphi process took place from February 2021 to May 2021. And then the triangulation phase was there where in all the data from different things, different regions, everything was accumulated and uh compiled onto a website with the option to leave a feedback. These findings were placed on the website in July 2021 and there were a lot of clicks on the website to around 201. Also by the time this got published and some 10 people left comments. Also, uh nine of them were actually already short course facilitators like us. Uh So this is the flow chart which is showing the stages of the study process. And uh the short forms have been explained here, African region, American region, Southeast Asian region and Western Pacific Region. I will go through this one by one in the next few slides. So how was the information needed identified? Like what are the items that can be included for a short course on postoperative care? So literature review was done and studies based on post operative care in low and middle income countries uh were looked into it as such post operative mortality morbidity is quite high. And that is, is the one reason why it was decided to go ahead with this. And also in uh in low and middle income countries, the morbidity mortality is much higher than in other regions. So, uh specifically this area was also chosen. So, exploratory focus groups that is the w festive facilitators included around 25 items from literature, 70 items. And the course of the group, the initiators included around 39 the total of one or eight items were included in this study initially. So the review was done and the pilot survey was done to see what all can be included uh for this short course, uh and who can do it and in what way it needs to be done. So, they were initially, uh this process took around three weeks uh in the first week and since were taken and uh, confidentiality was maintained. And uh the process was explained to each and everyone in the first week, the post operative care and the post operative complications topics were discussed like, uh where the, uh, where they work and who provides care after surgery. Who should, who is the important person who can take care of the patient in the post operative period. Questions like this were discussed and a lot of uh answers came up and uh regarding the complications also, what types of complications have been seen by all of them? And uh what, uh what are the most important complications? Why they are the most important and uh who should manage the complications? Uh, when is the patient most at risk for complications? All these questions were discussed in detail and noted down and in the second week, how do we teach on such a short course? This question was uh discussed in an elaborate way and uh, uh, like as we were all already involved in teaching on a short course. We had a lot of uh inputs uh to give. And uh even the COVID 19 pandemic had created a lot of change in our views. Actually, uh when we were doing WFC safe courses before on site, we would have some 20 or so of participants, we would have a 2 to 3 day course. And uh the participant to it would be mostly local and the faculty, sometimes national faculty arrive and uh sometimes international faculty to uh uh when COVID hit, it was completely different for us, we could not conduct any on site uh courses anymore, but life had to progress. And we decided to do, we're on online course, which actually went on very beautifully. We were quite skeptical about it. How we'd be able to reach, how would we be able to maintain the uh tempo between the participants and the facilitators and how do we make them because there is no hands on exposure for the participants. So how do we make this better for them? All such issues were discussed and a lot of preparation was done separately for that online course because uh in on site course, we would ask the participants uh to be uh do enact certain roles and the role play would come out and we would discuss about what happened and all, but there is no way that can be done on in an online goes. So what we did was we enacted those rules and put up the video first and then we discussed about the uh particular situations. So uh and also like uh we had to keep them engaged. So we had to cut tenuously discussed with each person separately. We had to keep it in mind that each one should not be left out. Because if they are in front of you, right in front of you, it is very easy to communicate. But when it is online, it is difficult. Such a didactic lecture would be easier online. But uh in communication that as a discussion that is a little more tougher and we have to keep it in mind that we have to keep all the persons involved. But the plus of that was that we could have participants from all over the country also as well as from outside countries. Other countries like few participants from Pakistan, Afghanistan were also there, which was quite uh surprising and a happy thing for us because we had other people, other situations which we could discuss. Uh and uh it was quite a unique way to deal with. So, uh so that's why the online teaching also only method of short post teaching also was proposed by many of the participants here, many of the panelists and um regarding who to teach, who should teach and who should participate. There are a lot of uh discussion's and a lot of uh proposals regarding who should teach and who should participate came up. And we'll be seeing that in the next few slides. And in the third week, all the content was shown and discussion's happened if anything different should be added and how to reach the intended participants for this study. That is a safe course facilitators. Uh And uh it was closed in the third week and all this data was captured uh onto uh computer software. So I told you there is a deviation, this African region around two had a lesser response rate. And so a post called a post hoc definition was done for this particular region when an item would be included in round three, if it was ranked four by 64% or more of the panel for the rest of the groups, it was if it is ranked for by more than 70% or more of the panel, because many of the items would get excluded if the a primary analysis was used a priory in the sense, it is coming from theoretical deduction only rather than from observation or experience, the obser observations and experience of the facilitators were utilized in this process. And uh because of the low response rate, this change had to be made. And uh so these are the five things that came up finally after the focus on the third round. And uh these include the patient and the health system considerations before surgery, anesthesia, and surgical care during surgery and monitoring of the patient after surgery ability to rescue the patient with surgical complications, common complications after surgery. So these are the items that were included under a patient and health facility. The items shown and read would have been excluded if the deviation in the African group had not been made. So several issues regarding the prognosis and risks after surgery delays in reaching surgical case tapping issues, short term health issues, age related issues, all were included in this category In the inter operative category, all uh had all were in agreement and uh all of them were included even in the African group. The other. Regarding the anesthesia and the surgery, there were several inclusions uh for each item. And uh next monitoring, a few of them would have been excluded if the deviation was not made location of care, effective nursing, the availability and level of training with the role of physiotherapy, critical care outreach services. These would have been included uh but for the uh post talk change. So complications were all included. System wise. Complications were included. Effects of COVID 19 infection were included and management of pain and nausea and vomiting was also included. Complications of ice you stay were also included. So coming to the ability to rescue capacity of ward staff to manage critical event was included a management of acute pain availability and prioritization of resources. And the referral service also was uh discussed. So the teaching methods and it came to teaching methods. A lot of different methods were included uh like the discussion group, the small group workshops, simulation, high fidelity simulation in a dedicated assimilation suit and prerecorded presentations, care stories from healthcare providers. All these were included facilitators uh were proposed like uh surgical providers and a surgical specialist provider. Uh sorry, a physician anesthesia specialist providers and international faculty also were included regarding international faculty. There was uh low response like most of them felt that the coast can be conducted uh without involving. Uh we'll discuss uh the details about that later. And participants, several participants have been proposed by everyone. And uh this is anesthesia providers, general practitioners, nurse, anesthetists, anesthesia, technicians, critical care nurses, operation, theater nurses, uh and other uh non specialist operatives service uh surgical providers also. So a data management and analysis was done as I told you initially with the Likert scale, assessing the frequency of responses and this always collected and managed using red cap software and then data analysis was undertaken using our for statistical analysis. So what we found in our analysis, the common things among all the panelists from all the geographical regions were that uh most items on common complications should be included on a short course. So they were all in agreement about the common complications or they also felt that fewer items can be included under post operative monitoring or pre operative patient considerations. Uh And also across all these themes, multiple I items were identified as important to include under short course by all of those panelists. So little differences maybe there. But overall, all of them had uh inclusions in all of the pie groups and all regions felt that preoperative topics could be uh the least important focus. So what were the differences among all the panelists uh among all the groups of panelists? So the main, the most important thing to focus for the short course was different for each of the geographical regions. With the African panelists seeing common complications after surgery is the most important with the Southeast Asian region and Western Pacific panelists saying that the monitoring of the patient after surgery is uh but most important. And American Panelist sing the inter operative topics are the most important. Also the preferred duration for the short course was also different with the African panelists sing 4 to 7 days is required for the short course. Whereas the other panelists agreed that 2 to 3 days is sufficient. So there was high level of consensus within regions regarding what is important for the coast content, but outside between regions. Uh it was quite different as we saw that they had different uh topics of importance. This uh says that in there set up uh they face different kinds of issues. The issues are not same all over the world like POSTOP care has uh like in drop issues so important for some geographical areas, some had other concerns. So overall, when we get to have a look at this. If we create or particular universal curriculum for this short course, then it may not actually need the needs of all the geographical regions completely. And some issues maybe missed out and some issues maybe not necessary to be discussed. Uh So that may uh eat up the time and uh the participants may feel that they're not getting what they want from the course. So all uh these things, if we keep thinking about it, we find that maybe we should look into a different way of uh creating a short course. Like you can have several modules of topics and you can include uh those uh uh topics uh what are required for a particular region wherever we are conducting that short post, who are the participants based on the participants. Also, the content can vary because if it is uh let us say post operative nurses, they will have their own set of problems that they deal with on a regular basis. So if we give them the content that makes them more capable of uh taking care of those issues, so they will be more happy as well as uh it is apt for them. So that way of course has to be a streamlined and conducted uh rather than having a universal thing for everybody. So universal curriculum has been for followed so far by different short courses, but going forward, uh I'm thinking mostly um this module based short courses will be more common. Coming in the later years. Also anaesthetist in operation theater, nurses were considered to be the key participants by most of the panelists. But the African and American region panel recommended more multidisciplinary healthcare professional participant rolls. Yes. Actually speaking, if you think of it, if only one group in the whole team, one person is trained uh from among the whole of the team, then the results may not be that uh plausible. And uh so if everyone who's in involved in the post operative care of the patient is trained together, that would have a better impact on the actual outcomes uh in the patient's is uh what I'm thinking. And uh anesthetists are the key facilitators according to most of the panelists. And uh we have, it has been so with the w face courses also, but involvement of other uh like others like the surgeons or the nurses as facilitator. Uh I think it would make the participants, like if the participants, our nurses, they would relate more to a facilitator who is a nurse and they feel more confident and uh they come out with the participate better in the course is what I think. And uh so even uh when different facilitators are there, it is a team in itself like a surgeon is there as facilitator, anesthetist is their nurses there. So they themselves are literally forming a team over there. A strong team which can take care of POSTOP complications. That is what will be reflected on to the participants. Also, also faculty from high income countries were not considered high priority most probably because uh there is a lot of travel involved with a lot of cost involved and a lot of carbon pull footprint. And also we as WFC facilitators have gotten used to conducting the short courses uh since years now. And uh uh we have, we think we can manage it on the regional level. It is easier, but uh online uh mode of uh teaching should not go away. I feel though we are uh going back to the on site teachings. I think a combination of online as well as the offline mode uh would be a better way of going forward with the teaching. Uh so that there is not too much of travel and the international faculty can participate international uh the influence like what they do in their setups and all that knowledge can be imparted. And that will give a global perspective to all those involved. And that is how we will be able to grow together. And uh the participants also, I think they will benefit from a global perspective and they will also come forward to be facilitators. So during our study, uh there were dropouts between each stage which was expected and uh reduced to response rates were there because this most probably is due to COVID 19 situation. Uh which was very rampant at that point of time when this study was in its final phases. And, uh, so maybe this, that could be the issue. There was a lot of stress about COVID back then and we were not really very much up to doing anything else. Uh So, and also, uh Iraq's concepts and, uh, like uh enhanced recovery after surgery, these concepts are coming into picture for the low and middle income countries also. And we are actually following these concepts in our post operative patient's and seeing wonderful results. So these concepts also need to be uh included in the course is going further down and it should be a dynamic, not a static, like we have developed a curriculum and that's it, it should not be the case and further going uh down the years, it should keep on evolving and including the better concepts that keep coming up and then the course would be much stronger and uh the POSTOP outcomes can be improved well. And uh as I already said, multidisciplinary panelists and the development of multiple modules would go a long way in making it a stronger and better course. So coming to the conclusions, our study provides an outline of key content to consider when developing a short course on post operative care and complications, uh the whole of the monetary it items and uh the inclusions and exclusions, uh everything are displayed on the online and everyone can go through those things if you people have any doubts and all you can get back to us later also. And uh the content we feel as I already told you, it should be guided by specific needs relevant to the location where the course is being held rather than by an universal curriculum. Thank you. Thank you, David. Uh your presentation. Um I think it came out then. So um just to add my two bits, uh as Shailaja said, we've been involved with safe courses since the 2017 when uh W F S uh started a four year project in Telangana, Telangana is where Hyderabad is. And that's how we all came into the picture. And uh this particular study was actually started because that there is the safe or course there is the trauma course, but there was not no course which is focusing specifically on postoperative. Okay. So it was felt to be an area of need. So, so that's, that's how the whole idea came up that we should uh you know, get some consensus uh regarding how involved and you know, who should do this cause that kind of thing. So the participants of this therapy, we're all safe in instructors. So everybody had a perspective of how these courses are conducted and why they are being conducted as well because uh we, no, I mean, the whole idea of the safe processes that you, you don't have to teach everything but everybody should come to an acceptable, safe standard of practice. That is the whole idea of the safe courses. And so anyway, so that's, that's the reason this, uh, whole thing about having a post operative, uh, course about postoperative care came about. Then, uh, in fact, you know, one thing comes out of another, like we did the safe courses, then we got involved in the vast course, which is something you guys should look at as well. If you get a chance, asked a while, he'll be able to tell you about it. Uh You know, there are these different different courses and uh uh the emphasis is different, like the safe courses are we want to get this particular content across to the participants. We want them all to receive this content, the content. Whereas if you look at the vast course, it is okay, little bit about the content is important, but much more than that is the interactions between people and how, how we all work as a team and how, what problems they had, how we debry to all those things come across in the vast courses which I strongly recommend that you guys look at and take the course if you get a chance. So um and then we have this new course coming up a word about the findings. Most people I think felt that uh you know, there was agreement on teaching methods. The best way is a small group, teaching because uh all adult learners, if you just keep giving them long lectures, they're not going to, you know, be interested or listen attention span is also limited. But if you make them interact and discuss, get involved in the discussion, that is going to be much more um effective in them, carrying away. And maybe we will learn from them as well. But that's another thing that we have to keep in mind that we are all at the same level and we learn from the participants as much as they learn from us. Uh And the variation between these regions is um it's reasonable because you know, you have different uh ways of working. You have different facilities like Ryan was just saying he's in uh you got it done. Yeah, and he's managing it very little. He's showing them how to give safe anesthesia with very low resources. I mean, the resources are different in different places. Staffing is different, the setups are different. So naturally the there will be variation between the regions of how, what kind of things should be included and how you should conduct the course as well. Even during the Safe for courses, we had to modify things a little bit like some topics in the safe pediatric was not really relevant to us. We don't often physicals and it's a rare condition. So we took that off. So we, you know, we modify things to suit our circumstances and our population And of course, the, as the challenger said, we did the online thing because because of COVID, so that was a great experience is very rewarding little bit uh tense making. But on the whole, we had a great experience. So anyway, um about what this uh study that was done was a very painstaking uh collection of data, collection of data so that we come to a consensus of what is the best way we can conduct uh short course on postoperative care. And in fact, we are in the process of developing a short course on, we are calling it the Safe Pack you course. And we have people on both sides of the Atlantic, were people in Africa and people in uh India uh participating in an you, you started writing content for it and hopefully, you know, if you come to some kind of uh vision, all this hard work going to waste. So, thank you very much. Thanks uh Ryan and Helen. Um It was a great pleasure being here with you guys were all we're happy to take any question, uh Any comments, ideas. Thanks, brilliant. Thank you very much to both of you for the excellent presentation of that paper, the presentation itself and, and the comments that followed from, you know, if that was was excellent and informative um apologies for the disturbance midway through, but that's okay where they had no idea. They were interrupting a group of global surgeons and anesthesiologists, we thrive and adversity and challenge to full on them. So, thank you for for delivering that presentation. Now, then, uh if there are before I continue, just to say, we're going to add a feedback form in the comment section just to give us your feedback just to help us improve going forward. Uh But for now, you have any comments or questions, please put them in the chat or even raise your hand. If you have the capability to, to use your microphone, speak yourself, that's, that's perfectly fine as well. So either option, please do while we're waiting for anything to come about. I just kick off, I just wanted to firstly say about the strength of this study and how looking at the different regions and any built to discriminate between the preferences for each region, which is something that sometimes it's all grouped together. And it's nice to see that I had the context specific learning opportunities. I was just wondering thinking about fixed curriculum versus modular aspects. Do you think there is still room for, for the traditional model that's safe, for example, as has put forward and not having a fixed uh homogenized curriculum curriculum that is, that is focused on some basic level of safe care that may be applicable globally? Or do you think that the shift really needs to happen for all groups? Now where we're going towards a more modular context specific arrangement was wondering if there's room for both or whether that shift has to happen. Absolutely. There is definitely Rupel boots universal curriculum. See a few of the modules are needed for all the regions. There are commonalities when we checked on all the regions. So yes, there should be some common modules which will be universal and that curriculum will be fixed and the rest of the modules can be picked and chosen by the regional faculty for their own participants. That would be uh I think more apt the other thing is like if some area is different in one, some area of management is different in say Africa from India, like your, your training, non physician anesthesiologists, we don't, we're not allowed, you're not allowed to have non a non physician administering the anesthesia. So when that kind of thing is there, you can actually have alternate models. So we have a lot of common modules and we can have for one particular module, we can have this for South Africa and the other one for, you know, somewhere else, that kind of thing. So I think there is a lot of room to innovatively about this and see what works first. That's that. Yes, great. Thank you very much. That's what I thought having, having that mixes is its way forward. But I think what's changed the appreciation, I think more of the of the modular context specific. I think that's, that's the, that's the shift what's come before is still required but that shift that modular context is what my thing, I believe. Fantastic uh feel free to raise your hand in the, in the in the chat or in the meeting chat, post anything. Um But just kind of waiting, I just, I just want to ask something more specific to some of the results. So I was noticing about the people who helped generate, generate the content, the anesthesia providers who have to generate the content received. The questionnaires are mostly physician, any statist. So uh 88 to 97% across the regions, I think was the result. And do you think if the content generators were from different carriers? For example, nurses or non position surgeons, do you think some of the focus in what would be required would change at all? For example, in the, in the ability to rescue category, which is, which is very, very interesting. Uh There were a few items for the African and American regions and one of the focus points that wasn't there with the ability to escalate care, which maybe not so much of a focus if you're already a decision, if it is, for example, that may be of great focus if your award nous perhaps the the ability actually escalate whereas was basic monitoring and E W S or 100%. So you do the monitoring within the ability to escalate was not so much of a focus. I was wondering if the um if people who, for example, more nurses or nonpositional states, whether a focus items such as that to the escalation or other items, maybe they would have more focus on more priority uh from their point. Uh If they had been included in the study, is that what you're saying? If yes, for the content generation just, just uh yeah, absolutely. Uh Because they will have a different, you know, perspective and focus and also among, if you know, the faculty, they would feel more comfortable. I think child, you mentioned that because they would be on the same wavelength, uh you know, when somebody's teaching them so that, you know, they don't feel that someone is coming and talking down at us than telling us something which we're not familiar with. But as you know, they can have a much more uh comfortable interaction if, but the problem is uh the whole course, the whole study started with looking at uh providers or, you know, instructors for safe courses who are mostly anesthetist. So if it's, you know, that that factor couldn't be helped because most of the state faculty are uh anesthesiology. Yeah, it was specifically taken up because it was pandemic situation and it was difficult to reach out to other uh faculties. And this is a group which has already been doing short courses and uh there, there will be more pro to uh working uh in this uh study is what uh was the uh reason behind choosing w physical facilitators. Uh huh. But in fact, people who are developing the safe packed you cause we have some, you know, nurses then nothing administrators and people like that were writing some of the content. And uh it has to be a combination of both, isn't it? Especially in the pack you or in the post operative period. It is so much focused on the nurses taking care of the patient's, isn't it? So we have to have input from them. Absolutely agree more. And I was going to ask about where a safe we could develop postoperative course. And it sounds like you ask, that's going to be interesting to see the development of that. But definitely, thanks very much, Helen Helen, please. You have a hand up. Yeah. Hello. So, um fantastic presentation. Thank you. That was really engaging and interesting. I just wanted to ask about what your thoughts are about clinicians um doing research in sort of very educational fields. I think this is something that's growing and it's certainly something that were involved in with gas out. We're doing a lot of work with frames of virtual reality um group who are doing surgical training and anesthetic training now. And I just wonder because I know we've come across some challenges whether you face similar challenges or whether you've engaged with sort of people are formally trained in education um course development. What do you think the challenges or opportunities are having clinicians doing research in an area of assessing education and how do we best engage with um specialists in that area? You know, like actually uh features versus us clinicians who are not formally trained educators. Yeah, exactly. Like what do you think? Like what I think it's quite difficult interface sometimes um because you have people who are trained as clinicians trying to change the education of clinicians, but sometimes it's good to kind of have educators involved. I was wondering if you, if you had anyone involved too, is sort of from a more educational background or whether that's something that you as the research has had to learn. Um within the process you were doing obviously with the Delphi process and other things. So we, we have been teaching, you know, working and teaching. I have been working and teaching all my life without actually being formally educated in education. Till I took my first a CLS forced when they taught the principles of adult education and you know, all that stuff, it was great because, you know, it just added a dimension to what I could uh give people, you know, because till then I had not realized there was so much, you know, um in, in the technique of education educating people. So we uh we don't have so many formal educators with us uh in our group. So we take on the role of educators as well. Is that the accurate challenger? Yeah, so most of us, our clinicians only. But yeah, involvement of uh specific educators, maybe you would make a difference. But to find uh educators who can be involved in this process is uh the difficult task. I would say, you know, 11 thing I have noticed is that when somebody branches off and goes totally into education and loses touch with their clinical uh you know, skills, it's not the same thing because their perspective things, I mean, when people are, you must have seen when people become professors of anesthesia and they're doing high level research into something, you know, the clinical uh skills are not always uh clinical perspectives as well. So I think it's uh if you're doing clinical studies, you should have a bit of both. Yeah, because clinical situations keep evolving. It's not like what we were doing 10 years back, we are not doing now, if somebody has gone into education only 10 years back and it's trying to educate us as clinicians. Now there will be so much gap between them and us. So it is better to for the educator to educate us uh when they are also a clinician rather than somebody who is separately, totally an educated. Probably. What is, what were your challenges you were saying? Yeah, I think those are some really interesting answers because I do agree with what you're saying. And I think our field surgery, anaesthetics, obstetrics their their apprenticeship skills and therefore your educators need to also be at the sort of coalface doing the work. So I absolutely agree with you. I think one of the biggest challenges is how you robustly assess education of, of, of medical and clinical skills. Um And that's something I think most clinicians don't know how to do. And um and I just wonder if there's a vast expanse of skills out there is that if we connected more clinicians with people who have more skills in education. And I think you're talking about some of the formal course is things like A L S A T L s. I don't know what else there is globally. But I think those are some good examples where there's been some good collaboration of sort of formal education with clinical expertise and they do do uh assessment in a very specific kind of way. Whereas uh maybe we are coming to it now, you know, but uh traditionally assessment of Cialis citic training or whatever part of the exams has been subjected. Okay. Yeah. So I think it's a new area. I think it's an area that's growing. And I think through experience, people like yourselves do become expert in both, but it's a lot of sort of trial and error rather than formal education. And that's not a bad thing. It's just an interesting thing to think about anyway. I'll let somebody else ask some questions. Thank you. Thank you. Heaven. Uh Anyone else uh please just uh, feel free to raise your hand, the hand, raise your hand function and I'll ask you to introduce yourself or, or just put in the meeting chat and I can, I can ask it. I'm very happy to do that as well. Just wait that, uh, just quickly while waiting. I just want to pick up since we're doing a remote session with people around the world. I wouldn't pick up on some of the comments made both in the presentation in the paper regarding remote teaching and learning and really focus on the paragraph made on the importance of carbon offsetting in global research and teaching. And it kind of goes hand in hand with the uh interesting finding of the low importance of international faculty were ranked low, wasn't so much required now is that shift happens in more and more training is occurring in on these sites. And but so firstly, the importance whenever a paper is published, the importance of mentioning that cardinals and importance of mentioning the efforts made in that regard, you think that's something that should be a main focus for, for all research and globally done now. And uh yeah, sorry, I didn't have jokers. I think um Ryan might have gone off the call. Um I think there was an issue with them with his connection. Um I don't think we got his whole aunt question. So maybe we'll wait for him to come back on. I just want to give an opportunity for anyone else on here that we can see a day on a Patrick Alison, Fiona beca favor. Do any of you have any questions whilst Ryan's reconnecting and back? Oh, I think uh okay. All right, apologies. Had a bit of an internet issue there. I'm not sure where I got to. Um But essentially I was just um yes, speaking about the importance of mentioning that Carbonyl setting global research teaching um publications really making a specific section on that. And just the fact that online methods ranked low, is that truly a resource limitation? And is there still a desire for that? Is there still usefulness for the the online methods a way of teaching as we, as you come away from the restrictions of COVID now, hopefully, um whether that appetite still exists and it's still practical as, as the Shailaja said, we have to have a, you know, combination of online and onside teaching. So it would help if uh you know, most of the teachers and participants don't have to travel much. They're all in the same uh geographical area where as if somebody has to come from outside. I mean, that that is a huge big carbon footprint, isn't it? But you gain from um knowledge and perspectives coming from outside as well. So maybe, you know, some of that can be on, you know, in person and some of it can be online so it can be, you know, everything can be a combination of uh uh online and on site. But as we were saying, we have to think about the carbon footprint of especially, you know, uh international travel. So the study itself was done totally online. But uh what uh further is going to be done regarding the study, like a short course is created, then what happens it has conducted some so definitely travel is there from the National Faculty or uh some of the participants coming from elsewhere? So further down the line, we do see that we are definitely increasing the carbon footprint. But yeah, we try to limit it as much as possible regarding online uh education. Also, there are a lot of issues with the like the internet connection that uh the glitch we had just now so that can keep happening and then the education um doesn't really happen in a streamlined the flow so that then the participants really distracted and you know, online, they keep doing something else along with doing the course. That is one thing I've noticed online courses like the participants, then they feel that they don't need to take a leave from work and they keep working as well as attending the course. So whatever just we want to give them whatever education we want to give them that doesn't go in. Holy is what I feel that is why I am particular that it should be on site with online content of little bit of online content. Uh So that we do have a overall global perspective, but still we have the participants uh total attention. Also, we face some of these challenges when we did the online sage course in uh 2021. Was it 21? So uh you don't know whether they are just connected, you can see their name but are they there or not? We don't know. So what we did it, we did like, you know, many attendants wrote out like after each module, we gave them a few questions and they have to answer it. So if they answer it, we know that they have attended and they're, they're, you know, because, well, just imagine maintaining your attention for the whole day is, you know, not going to be easy for anybody to, you know, keep focusing on the, on the screen continuously. We gave them gap and we did this, you know, repeated uh like we have the pretest and both tests, but we broke it up so that we did it several times and use those as like attendance, you know, that demand their attendance, that television. So all these other and of course, we couldn't assess skills. If you're going to teach skills, it has to be impressed whatever the carbon thing, but somebody doesn't have to come from across the sea to teach the same skill, whoever is, they can teach it because that I'll be per it's all Right. Thanks very much. Thank you. And uh yeah, it was good timing on my part to show the limitations of remote teaching with internet glitches. So I was happy to uh to do that. Great. Fantastic. So I think unless there's anything fine or any final points, I think I'll leave it there. Unless there's any final questions anyone would like to ask. I'm just having a quick look. Any hunch raised, please come in. Uh huh. And I think that I think, I think that's us. Fantastic. So just just to finish with a very warm thank you to our two speakers dot Now, that's leisure for the presentation. Thank you very much for joining us today on a Saturday. And thank you for presenting the paper, which is again, as I mentioned at the top of the bill, very timely and important subject and post operative care and combining that with education which we spoke about. Thanks. Thanks to your question, Helen, which is also wrapped up with this so to really big and important topic. So thank you for bringing it. Thank you. Thank you very much. Um So before we move on, just a reminder of feedback, please, for the attendees, uh that will be sent out to believe our email, but it's also in the chat function. So please do complete that for us. That helps us with all our future events. And speaking of future events, our next gas sock Journal Club will be on March the 29th. That's preliminary dates they can change to keep an eye out on our so sure an email and so forth. That's uh currently though March 29th, seven PM GMT. And interestingly enough, that's going to be with Professor Picard and Doctor Victory. Uh regarding the cases to trial, that's the African surgical outcome study, two trials. So again, link to post operative outcomes. So a very strong postop protein thus emphasizing the timely nature of the subject as I mentioned. So that's excellent. And then as I said at the beginning, the second of February is our introduction day for the launch event for the Frugal Innovations course, which I encourage everyone to attend. And that's a launch event for a subsequent 89 month course, month, much monthly marginals all 33 to attend. So please have a look at that. So I think that's all unless haven't. Is there anything you'd like to add? No, it's fantastic. It's a really, really interesting session and we'll be putting up the recording on to our youtube channel. I'm sure people will be catching it up, so I'll stop that now.