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Great. My name is Rachel Colson. Uh I'm the Northern Irish representative and um alongside Dadri today, we're going to chair uh the session. Um This is going to be on rebuilding training. Um We've been esteem panel of judge of uh speakers here who first of all, we're gonna introduce his professor Colin Melville. He has a significant experience and expertise as a senior medical education list and NHS leader with previous roles encompassing clinical director, medical director, director of medical Education, and foundation school director. He also went on for academic leadership positions at Holyoke Medical School, Warwick and Lancaster Medical School before joining the G M C as Medical Director and Director of Education Standards in 2017. He's an honorary fellow of the Academy of Medical Directors, honorary Professor of Medical Education at the University of Manchester, and visiting professor at Anglian Ruskin University. I'll let you take the stage. Thank you. I'm also human. So it's great to be here and great to be able to talk to you. Uh I can't in the 10 minutes, I've got tell the whole story. So I just want to tease you with some thoughts and some challenges about how we change training cultures. So I don't know if you've ever asked yourself this question and we don't have time to take audience comments. But if I use the word culture and we use the word a lot, what does it mean to you? What is culture? Because we talk about, we need to have a just culture, a changing culture, we need to be culturally competent. What does all that mean? Well, of course, the important thing immediately is to do a systematic review of Google and this is what you get. So actually, it's interesting that it comes from a Latin word for those who are interested, meaning to tend the earth to nurture. And actually, for me, that's quite a good word to bear in mind. Are we nurturing in the cultures that we create? If you go to Cambridge English Dictionary or life science dot com, American website, there's something about it being about behaviors and in, in meetings in the past when I've asked this question, these are the words that come out. It's something to do with values, it's something to do with behaviors. So this is the definition that I tend to work with because I find that the most easy culture is determined, it's not defined and it's determined by the shared values and behaviors of a group of people, an organization or indeed a society, which means that you can have a culture in your home that is different from your culture at work because you're with different people. And it therefore means that we have to be challenged about what our values and our behaviors are. So let's have a look at some statistics which are derived from the N T s from 2022 from our recent progression reports that was published earlier this week from the G M C but also from some data on data explorer on the G M C's website, which you can find yourself. So here's the first thing when we look at doctors on the register on the left is the proportion of white B M E, we can do it the same for uh for gender. And we see that actually in surgery, a much more larger number of white and I will also tell you but you know this anyway mail. So then if we think about the training journey, if you're coming through from F two, applying to ST one, then what we've got our applications where, which are in higher proportion of the numbers from those who came from A UK qualified PM Q but who are non white, ethnically slightly higher proportion. But less of those are deemed a point toble even though they have a higher average short listing score. But once they get an offer, the acceptance rates are the same. But here's the real rub if you are an international graduate. So holding an international postgraduate medical qualification from a university outside of the UK application proportions are similar, but look at the numbers that come through. And that is, for me quite a stark difference that we need to start saying what is it that's leading to that. I don't have the answers for you this morning. I'm being really honest about that, but I do have lots of questions that I think can help us to think through what we can do. So here's some data from the N T S in 2022. That blue line represents the average of all those who reported uh in the survey. So it's around 75,000 responses and the blue at the right hand end which was about the question which is I've not experienced any rudeness or incivility. So that's the question. Do you experience rudeness or incivility in the post that you were in and for all trainees in this sense, that's all surgical trainees across the top. That's the average just under 20%. But you can see based on your ethnicity, it's different. And what strikes me is the not known group who are strongly agreeing or agreeing that they're experiencing rudeness or incivility, but don't feel able to declare their ethnicity and they are highly likely, but I can't prove it to you highly likely to be non white, non UK doctors that's not acceptable. Let me give you a second example. Have you experienced or witnessed bullying in surgery? Again, the blue line is the average of all those who return their responses in the sir in the N T S in 2022. So all trainees and you can see that in surgery in all of those ethnic groups, there is a higher proportion of trainees who experience or witnessing bullying. But let me ask an additional question because this question doesn't say who are those who are bullying and it is not exclusively those who are in senior consultant positions. I was on a visit to uh an organization a year or so ago. It might be a bit longer than that because it may be pre pandemic. And I remember hearing evidence that it was the more senior surgical trainees who were bullying the younger surgical trainees rather than the consultant. So let's not think that we individually are exempt and that all of these things are created or caused by other people. We may ourselves be guilty of this and we may or may not realize that we're doing it. I'm not going to talk about unconscious bias because my belief is that unconscious bias training just means that your bias is now conscious. What we actually have to do is think about how we understand our biases and what we can do to mitigate the impact that they have on other people. And here's the last I think of my slides just drawn from there. So in the column, which is quite hard to work out here. That green bar is the average response for the quality of teaching. And you'll know that we reported that generally the quality of teaching is very high. Going from left to right is whether people think it's very good or good. And the left hand end is general practice and you may not be surprised at that, but ladies and gentlemen, at the right hand end is surgery. So the quality of teaching, although you might say is good, but what, what is good should it be 100%? In fact, but it's 60 something percent. I can't read the number from hicks. I'm wearing my glasses 64%. So you're in a group of uh in a training group where there is discrimination or disadvantage based on ethnicity where there is a higher degree of bullying and harassment and incivility and where the quality of teaching is perceived as being less good than in other specialties. I am simply presenting to you what the data shows. It's not an accusation. It's an opportunity for us to think hard together. This is, I think the most interesting one for me because we asked the questions as you probably know about burnout and it is a validated inventory. In spite of the fact that people say, well, the questions lead to answers, it's been validated. So for those who have low risk of burnout, two features stand out. One is that they work in an environment which is fully supportive. And two, they work in an environment where the intensity of work is not heavy or very heavy. So that's the top line. But if you work in a place where the opposite is true with your work intensity is very high and you don't feel supported and there may be some relationship between those two things. Of course, it's not just about the amount of work, it's a sense of intensity. How much is there a good team working together? But if you have those features, then you have a very high risk of burnout and what does that potentially lead to? So this is cumulative data only up till 2017. So apologize for not updating it. But I have another slide. I'll show you next. These are the outcomes of exams that show overall the difference, the percentage point difference if you're a U K white doctor versus if you're a U K nonwhite doctor. So all those who studied and learned in the UK, who are probably UK passport holders or who would define themselves as UK. So that's not even looking at those who I MGS where I'll tell you it's even worse. So you're not the worst red means that we have a high degree of confidence that that difference exists. But if you then look further on the right hand side here, we've put together and I appreciate maybe you might argue this is not data that you can aggregate, but just to illustrate on average when we look across all college exams, the pass rate for white doctors is around 80%. And if you're a black doctor, which is the green line on this graph, sorry about the color's not, maybe, maybe not logical. Then that rate is only around 65%. If you look in surgery, there's some big swings. Now, I should tell you that in 2017, uh that, that the numbers of people make a big impact on the percentage as well because you can imagine if 11 or two people have different results, excuse the results. And in 2020 there was an issue with the surgical exams. So there's also a dip there, but the overall passing rates in all groups are lower. Now, I don't know if that's right or wrong. I'm just highlighting that that's an interesting difference. So I know that there are a lot, lot of people who feel it's really important that we get the right thinking about what should we be aiming in terms of what assessments are for? That's a different talk which I debate on Twitter with Simon's Fleming. So I think I've talked to you about culture and I've asked that question, what are our values and behaviors? So I want to just show you quickly to other slides. Uh The last slide of this, by the way, has the QR code for both these documents. If, if you want to grab them So first of all, I want to talk to about Michael West's work. He wrote this originally for the kings funding Caring to change before he wrote the pay the paper report for us uh on caring for doctors, caring for patient's. But I just want to ask you the question, how compassionate are you when you are at work? And I accept that we are in very challenging times in terms of the environment. But actually compassion is a core cultural value. Do we get alongside people? Do we understand what they say? Are we able to empathize with their perspective of things, even if we don't agree with it? And what can we do to help make a change? So that's the second part about culture. And the third one is this, this was actually written, this is a report by Alice and Catherine who were two of the G M C fellows back in 2019 and they published this report, but I don't think it's been widely followed, good conversations, fairer feedback. And they've given you some qualitative quotes from different people about their personal lived experiences. And it is very clear that if you come from a a non white ethnic group, your experience of how feedback happens is much more negative. So my argument is that the lived experience, we have the culture that we create leads into many of these other things and therefore we have the power to change them. So here Uh And lastly, just to show you very quickly, sorry, I'm probably out of time. Uh is that mentoring? This is some work from Harvard Business Review. Mentoring significantly improved the progression of people from non white backgrounds. That's why I've highlighted on here and I have a view and we mentioned it at the surgical forum last year that actually we should use mentoring much more. That's not the same as clinical supervision or educational supervision. It's someone that you trust that you can go and talk to that you can seek advice from and talk through things. So here are my three key takeaways in this short session. Firstly, I want to challenge us all. What Axion can I take to change culture, not the expectation that it's down to the execs or the board. But what can I do? Because if everybody who comes to this conference and I believe there's over 800 people made one change or if everyone who is at the dinner last night, which was awesome, by the way, made one change, we have the power to make change. Secondly, what can I do to show more empathy and compassion towards my colleagues even when it's difficult? And thirdly, how can I improve feedback conversations? Thank you. Thank you so much for, for that. Um We'll keep the session moving and hopefully, if we have some time at the end, then we can open the floor