Introduction to Surgery



This session is an introduction to General Surgery and is perfect for medical professionals looking to apply for surgery. It will explain what is involved, the skills and qualities needed, the pathway to becoming a surgeon, and what a typical day looks like. There will also be advice on how to make yourself more competitive and advice from the Royal College of Surgeons on courses and events that may help. The session will also be available for viewing for anyone who is unable to attend.
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Learning objectives

Learning Objectives: 1. Participants will gain an introduction to the field of general surgery. 2. Participants will understand how to become competitive in a surgical specialty. 3. Participants will comprehend the day to day of a general surgeon. 4. Participants will have knowledge of the college and training pathway for surgeons. 5. Participants will be able to identify courses, events, and collaborations for their portfolio.
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The following transcript was generated automatically from the content and has not been checked or corrected manually.

or so you never know. So this is great. Start for us to get introduction to surgery. Hard to get into it. What it is. Do you have Ah, uh, plan of becoming a surgeon or not? We all have to your surgical casements throughout the next few years on have to depart. Oh, Mother, would I could or not. So it's definitely It's definitely gonna be a good way to get some questions answered and see what it's all gonna be. A battle. Pass it on on at the end, we're gonna have our menti I question as well. And just so we're clear, everybody, this is being recorded. Eso anybody who's not able to attend can converse later on. So I think Alison, you're going to start you. I'm just gonna share my screen here better with me. Uh, show the right screen because look. Okay, so So you guys will say Ms already this has been the social media advert for tonight's events, and so I'm just gonna talk for but hopefully just about 20 minutes and just a little bit of bite. What general surgery is Hi. I got into it high. You can get into um, things you can breathe. Overview of things you can do to make yourself more competitive for, um, if you want to apply for surgery after you finish med scope on, then, um, go through. Sort of a typical weight your day in the life of general surgeon. Yeah. So, yeah, once me eso general surgery is one of the two most common types of surgery in the UK, And with this other one being tea and our trauma north picks, we dont wide range of stuff and both elective an emergency, um, mentally acute abdominal problems. But we do a lot. A lot of elective operations, a swell and actually a lot of the elective operating. That idea is actually I did with my subspecialty of colorectal. So things like hernias and Goldwater's things like that. They're quite a high proportion of emergency work. I'm in emergency surgeon one week and six. Um, there's quite a lot of some specialties within the general surgery that you can pick today. It is an intellectual challenge. Don't ever let people tell you that. Search and search. Um, there's some of the smartest people I know. Um, and also, you could do something very practical to improve patient's well being. And it's a really privileged today what I do, I say That's all the time to medical students. You know, patients are trusting you out there, most vulnerable. They're asleep on a table, untrusting you to do what is right for them. Um, and I think that's just a medicine that amazes me every day. It will trust me to, um, in their bellies. What's going on? No, no, let me. Which What's your general surgery? No, uh, could everybody meet? They're microphones place. And so there's some especially has been general surgery at Breast and the Quran, a soft gastric colorectal HPB on transplant. If any of you do, you come to cause way for your place and actually all sex bicycle rectal subspecialists. So it's actually very useful. Well, what we could do with somebody for, um, it should be in a G i o. So what do you need to be a surgeon? We need really good communications. Ghosts. This was not seen with any doctor, and you're going to get with colleagues, patients, relatives on other teams, especially on Celexa or sex stuff zeros. My nail dexterity. Most people can be talked to do it. The very few people who can't be told to do an operation and you need the ability to adapt and surgery things that don't always go according to file. And you need to have a Bombay A Plan C In a pump day on, you need to have the ability to learn the skeleton techniques. Those things always change. You're generally seen a PSA. Later or so, you have to be able to inspire confidence and alerts and bring them along with you. Um, um, you need a passion for your special day and most people do you help that emotional emotional resilience is important as well. Um, you know, support. You're taking three difficult times. So what did I choose? Surgery? Well, I to surgery back way back in 1990. It's when I was a third year medical student. Um, it's true. Well, my career conflict life, but I started. I interviewed for medical school in 1995 for a long time ago, and I and actually interestingly, get asked what I would do if I wanted to do a meal dominated specialty, which I think my reply was, I don't see why that should stop. May, um, not that I don't know, should have them surgery at that time. But when I was 30 years medical school, my placement was in the hospital. And I love that. It's for just really passionate, right? They're subject to me. It was really interesting. You could do something very practical to help people on. That was May I was sold. So finish med school in 2000 about time and it wasn't finding issue program. I was a pre registration heist office for a year on the street and they're forbid surgical training for two years. Did my MRI CS about time in 2003? Um, then 2003, 2000 and five was another couple of years Is net. That's a senior S H O in general surgery and pediatric surgery. Actually, it was time to start thinking of my higher surgical training. Um, while I was trying to get an interview for that, I worked us what's noticing lately, or look up appointment for traveling free or trust Sergi. So it was that registrar level, but not with training number. Alongside the end of my job time on my time is allowed. I was actually doing a masters a swell, and I didn't see an advance Surgical practice finally got my number in 2000 and seven on higher surgical training A six years. And so I finished my training in 2013. Before you finish your training, you have to do half RCs, which fellowship with the Royal College Surgeons, which I didn't 2012, singularly one of the worst exams I've ever done on. Then I got my results. See, in 2013, I worked as a locum for about four years, like in in my permanent job. Now for nearly five, alongside all of that multiple public stop strikes, a few care reviewed papers. So it's quite a busy time training to be a surgeon. You know, much free time pathway looks a little different. My, um, you have two years foundation training on, then, um, course surgical training, which is two years. So there's two selection points in surgery court reeling on specialty training, so you can see there in 2021 there were 670 81 post in the UK on 4.1 sex complications proposed, um, sort of similar numbers for specialty training. So it is a popular specialty, and it is very competitive. Um, get into S t three. You need to hook it on your arm or C s on your mom's history courses. So things like, um HDLs crisp some people and we'll do a fellowship for a year. And somewhere in a different country, usually some people stand the UK Some people go away knots to get more experience in the subspecialty that you've chosen. I actually didn't get a fellowship. I just went straight into my consultant job. Um, so then you see C t cells completion of training, certificate of completion training and then hopefully then a consultant job after that. So if you're thinking of surgery Hi, can you make yourself competitive? What sort of things can you do? Well, so if you've done one of these already, Steve joined surgical societies in the gel. It's very active. University surgical societies not really gauge. It gives you lots of opportunities to teaching network with other people and makes your CV look good. I'm gonna put a plug in I for the Royal College distortions of adding a student network which you could join for Tampines a year on that's allies you to have access to their knowledge tub with Webinars and you can get assess toe Ackland anatomy for your revision. Just the things that are stories and groans for electives. Um, online disc kinds for medical books on D support from the regional. So my surgical advisor network. So there'll be a consult with the national spell here? Part of thought you could give you advice and then drink Onda. Also, the college cannot get you with relevant courses and events that may may help it. Um, this is probably way off yet. I'm not sure the you guys do one of these me to do certain queens to do an elective final year. You could do a surgical elective. Not sure your interest. I did mine a pediatric surgery and cat Monday, actually. So that was an interesting experience and what I probably wouldn't have had if I didn't do much. Then there's other things. Look different surgical prizes and Ward's you're getting involved in research holdups, um, quality in crave mint within the hospitals that your your based in and you can actually start a surgeon, a look, But why you're a student decon and sign up for a job, but complete in case is that you deserved it. Just gives you just a little bit more for your portfolio when it comes to applying for jobs. And this is something that's very useful, actually. Start, Sergeant, I know a lot of our students terrible with this. So the student odor and research and surgery collaborative it was this big student land network through UK will look kind of go medical schools on the republicans. Well on, they've actually got a lof big publications and big journal. So that's a good thing if you are interested in surgery and interested in some research to really good collaborative to be involved in. So what I actually day so interestingly remember a third tier med student? Also for sure you must be in theater like old every day. I'm actually operating is a very small part of my job. So in Normal Creek, over times, I would do endoscopy on No, that's not true. That's what I do know. I would have done day surgery on a Monday mornings. That would have been things like who her is? Lots of bumps. Circumcisions? Um um, Botox hemorrhoids, small things that are are day kisses in the afternoon. I do night patient clinic on again and break over times we would have seen somewhere between 30 and 40 patients and then afternoon. At the moment, I can see 20 generally because of the social distancing restrictions in the way I write more than anything else. Tuesday morning is not men's fashion, but there's more albumin than confront and walls action. It seems to multiply increasingly in my office. It's gonna bury me one of these twice. She's afternoon was scope. So does it is calling off screens. And plus we'll see what else? Craze. Thursday mornings night. I did joint clinic with a gynecologist, a nontraumatic, an interest in pelvic floor disorder. So I do have paraneal clinics. One of the gynecologists Thursday afternoon is supposed to be my educational afternoon, where I do things like a little research stuff for my portfolio, for my appraisal that I offer it Old Day on a Friday. So operating is generally are happy place. My patient clinic generally quote not quite so much. Um, I also search in the wake, So when we're in emergency surgery. We either do three days on cold or four other started Friday morning, finishing Monday morning or start on Monday morning of finished on Friday morning. And during that week, I'm responsible for all emergency surgical admissions. Come into the hospital. I am on call all of that time, and they're all admitted under my care, so that could be a bit variable. And what comes in on high busy it is most of all teaching amounts. Um, here tonight, some undergraduate modulate for Queens surgery for calls way on, Also an educational supervisor here, some of our core trainees on higher training's. So that's quite a lot goes on and on about Ready. Just so I got some pictures of the kind of variety of stuff that we do use the general surgeons. You know, it's an excuse to put up a few gross pictures, so you get perianal abscesses. The top right hand corner is a gold bladder. Cholecystectomy Appendicectomy is do endoscopy. Avery get bile counselor Crewman's disease structures in the bile diverticular disease. The CT scan shows pancreatitis, small ball obstruction, somebody with perforation, the chest X ray on the top, right shoes preparation for a year in the abdomen on, um, the bottom line. So she's shows some subcutaneous and same. I think this gentleman actually help himself. Geo preparation. Um, other things with a large foil obstruction big X ray there, somebody with the pneumothorax getting a chest re and put in. Sometimes this does happen. My have in the last two years later the patient up the theater with a knife sticking out of their epigastrium. Much to the horror of our surgical secretary, um, who is sitting on the front desk, thankfully, haven't done too much damage. Um, so it's quite a variety of stuff that we say on a daily basis. My preference would be spend more time in the operating theater, but unfortunately, it's more like the top, right? We're really Maybe if I just ignore my paperwork, it would go away. Unfortunately, has not happened yet, So advice for surgery be enthusiastic. We love to have these aspects treatments. You're interested in what we're doing. Um, it makes us remember why we did it in the first place. Um, you will need to be determined, the thoughts, what you want to do. It's not an easy road. It is hard work. One of the best piece of advice I ago was be yourself. Mm, I got told I didn't needs to be a mom to be a surgeon. I didn't need to lose my family in a day. Everybody fits in surgery. I think there is a stereotype like they're I think that's dying. I mean, I on Do you know you don't have to be anybody else to To be a surgeon. Just be yourself more card. Look after yourself and your colleagues and medicine as a career in general is old consuming or can be a little consuming. So it's important to take time. I spent time with people that you love do things that you love today, Um, spend time with your family and friends because that they'll be there for you to, um you know, like the short bones will replace you when you go. But if you want it, go for it. I would go back and choose it again. For all its faults, Um, I definitely still like my day. It does get me into some really interesting situations Some of you may not remember, so I bought 2015 there was a campaign all Twitter think it started with. I looked like an engineer with some young lady. Hey, very young, attractive woman. He Nobody would believe what she that's what she did. And then somebody said, Oh, we should do that for I looked like a surgeon. The line was like, Well, what does the surgeon looked like before? I was the first person to reply to it, So I ended up on the BBC website. No, you know, which is not something I ever thought would happen. And on it still was on. I'm not susceptible talking about women in surgery tonight. That's a whole other token itself. And it's a sad indictment that still women are being told that they can't be sergeants in 2021 or 2022. You know, there's a tweet there. You know there's girls san. I've just had, um on the Internet Tell me that because I'm a physically inferior to mom has scientifically worst time like ordination. That's why there's a gender gap in search. Um, I also ended up doing a podcast for the quality commission. Um, what what it's like to be a female and surgery way when you make up, like 13% of consultant general surgeons, Um, so get yourself into old sorts of scripts, but you take, like, an extra from Harry Potter. This is me at my at four. CS graduation in 2013 on. There was a very proud moment because that's a lot hard work to get that for. Okay, thanks. So I think we're gonna have a chance to do some questions at the at the end with mental meter, so I'll see about my screen night. Um, let's see. You should be able to see that same title, slightest. You'd say introduction to surgery. You can see that. Okay, Excellent. Okay. So thank you very much for asking me to come. Um, on being here, I think it's really it's a privilege to be here on the very first meeting of a brand new surgery society and a brand new medical school like you don't get this opportunity very, very often. I thought I would talk a little bit about it. What my journey has been like over the last 25 years or so, and you'll see it's the same. In some ways, it's Allison's and different in other ways as well on. Then I'll talk at the end a little bit about kind of my reflections on where have bean on. But what? My advice for you would be, um, about surgery at the moment. So, really, this is this is kind of where being so far. So I was born in 1968 on Grew up in west Belfast, Um, on the Shankle road would actually, um, on about our parents moved a site in 1974 and move down to Carrickfergus on the family's been best here ever ever since. So I agree up during the troubles, which I mean, most of you guys are so young. You probably don't remember this stuff or you don't quite believe what happened. But this is exactly the kind of thing that we were going up with with bombs and soldiers and stuff and all these people running around This is me as a medical student, actually. So we got to remember, um, back then there were no iPhones. There were new laptops. There was no internet. There was no wife, I think is me studying on. Actually, I'm the first person in my university my family to go to university. So these are second on tax books on a borrowed human skull. On This is my parents dining room. And clearly I was a very serious medical student because I I put a tie on so that I could study, apparently was quite a formal thing, studying on and making just the way you guys are making a bunch of notes and noted notes. So I started 9 87. I got invited, do an interplay, did degree ended a battery, medical science as well as the medical degrees. And I got out in 90 90 93 on this is my graduating class About 100 50 of us, Um, in 1993 and I am just about here over on the left hand side were in a really low shirt, actually. So I was a host man in the city hospital. Then I spent a year there on then the advice that I got if I wanted to surgery was to get out off Belfast, so I actually went on, did some jobs in the Antrum Hospital. Um, I did six months and general surgeon, six months in emergency medicine and then came back into the the Belfast rotation after that. And I think I remember it was, uh, I think I did six months? No, I did four months geriatrics straight out of medical school and then four months surgery and then four months. Cardiology on the surgery was the one that seemed to make the most impact, like a seem to be the most immediate on the most gratifying. That people would get better and go home very quickly. So I think that's why I was interested in doing surgery. So then I trained in general surgery and later on colorectal surgery in the Northern Higher Surgical Training program. I think I think, Alison, I probably cross pass in towards the end of my training here. I think Alison might have been a nasty it show when I was a register on the Ulster Hospital. Um, I got invited to a Masters, and then and then a PhD is Well, I spent some time in the states, um, finishing my PhD on, but finished my indoor that I'm training 2004 on. But I applied for a bunch of different fellowships again. You're encouraged to kind of go away and get out of the country for for a year at the end of your training. Um so I was I had an offer from Adelaide on from South Africa and from Hong Kong. I think we're due to the places that I was thinking of going. But I ended up going to Canada and I did a fellowship in surgical oncology at the University of Calorie, which is in our Berta on our east of the off the Rocky Mountains on by ended up doing kind of accidentally, I got asked to do a master's degree in medical education while it was because I was interested in education. So I I did that in Calgary on decide if fallen and I we basically fell in love with Canada. We fell in love with the Rockies. We fell in love with the people we fell in love with the life on. The funny thing was, it was a two year fellowship, not a one year fellowship. So you actually got some time to really prevent a route to think about? What would this be like? So when a job offer came along, was actually a English guy who had moved to Alberta on, he said, Would you consider staying on? But we kind of entertained that it's able to stay for a bit and see what what happens on dot so that that's how the job in Canada turned up. Obviously, it's a pretty cold place. It is winter for about six months of the year. It starts the snow falls and the beginning of November on the state's through until the the middle of April. So you have to you have to like cold. You have to like snowboarding and skiing and getting out in the in the winter time. If you don't like snow, probably northern Canada is not not too hard for you. Eso I've been at the University of Alberta and admitted, which is the provincial capital off Alberta for a bite. I guess. What's 15 or 16 years now from 2006? Um, I have an academic position there. I'm on the 10 year track. I finish with that. I'm I'm a full professor of surgery. I serve for about 10 years as an adult chair and education, So I had to research chair. I'm also a three AM teaching fellow and the senior medic, Tractor of Surgery and Albert, and I'll tell you what that means when we come to the end of this. So for 10 years I was in charge of undergraduate education and surgery at the medical school for all four years. So you'll see this is our medical school class, and there's a fight. 100 and 65 um, students in Edmonton. This is their introduction to surgery lecture. So we actually give them hats and masks and get him to dress up a surgeon's for an our talk about what is going to be like when they're in the hospitals. I spent quite a bit of time developing a a resident teacher training program as well, so we make sure that every single surgical trainee is taught how to be a teacher, and we actually take them away to a place and called the bound center in the Rocky Mountains. You see, the snow in the background initially was just for event and night for the whole province, actually, so we take a boat 15 resident of stone for about three nights in February and T's invited teach. I also developed a new graduate program and surgical education. So these are some of the graduate students on when they graduate, know they get a masters in science and surgical education, and we've got a research lab and all that kind of stuff. You can see some of this stuff set up in the background there. My practice is actually quite like Alesse since I suspect this is where I work at the Royal Alexander Hospital. Um, I have a clinic. I do scopes. I operate on dime on call a swell on. But I started practice in 2006. I took the decision that I I wanted to be purely electronic, so I don't have any charts. It's all computer based, so I'm able to track all the patients I have seen. So I've seen about 25,000 patients. I'm over the course of that 15 or 16 years, I would say about 30 or 40 patients in a in a Friday clinic run. About the same is Allison. I would do about 14 colonoscopies a day. When I'm in there and ask to be sweet. I probably operate three or four well, maybe four or five days a month, actually, and typically if I'm doing small cases. I'll leave it be 5 ft, five patients per day. If it's a bigger cases, I might do to to cancer cases a day in the operating room on calls. Not too bad. Actually. There's 14 of us in the in the General surgery group. Know? So I'm only on coal two or three nights a month, actually, which is nice for the 1st 10 years, I was on call for trauma surgery as well. Um, but about five years ago, we have a separate trauma service develop. So luckily, when somebody gets stabbed in the night, I don't I don't have to wake up and come and see them anymore. I think as a lotta had mentioned earlier on one of the things that I've done, which is, I think quite a wide impact. Is this thing called surgery? One of one, which is a podcast and an app on your phone on dive explored like, what happens when you take a snowboarding camera and bring it into the operating room? What sort of footage can you generate? Um, how do you make an educational resource out of that? So if you go on, we have a YouTube channel and everything. You can actually go on, look and see. How do you do A lot of problems like, What is it? What is it like? Is it done? What's it like when everything gets gets opened up? We've also spent a bit of time with this project called Surgery Wanted. One studio is working with some filmmaking students, actually, um and they give us some ideas that we developed likely. So you can see we actually, this is a rail operating room. It's not not made up on all the really waiting room where we actually filmed Muppets doing surgery. We talked about things like the surgery called safety checklist and that sort of thing. Um, so again, you could go on our YouTube channel or on the APP on DA You can see some of the videos made a bite. Muppets. We've also done quite a bit of stop motion animation using Lego. Well, we've done a couple of videos using zombies. A swell. So we did a video called Zombie Surgery, but I had a situation on. We've done a few videos on physical examination based on start drink. A swell been relatively creative and a little bit outside the box and using odd ways of of kind of teaching surgery. Um, so I would say it's it's available online. You don't need to pay for it. It's all free on the Web sites at the bottom there. Surgery 11 dot don't order. I'll talk a little bit about that again at the very end, cause some of that stuff quite relevant to you when you're when you're reading the hospitals next year. We are actually making new episodes work when I get back to Canada, starting in early 2023. So I'm looking forward to the first medical student from University of Elstree milling me to say, Hey, I want to make an episode on such and such a thing and we typically parry up with an expert on a particular topic, and then you can develop an episode that then gets broadcast. Uh, the last thing I wanted to mention is over the last three or four years, I've actually been working Maurine Medical Leadership, um, with Alberta Health Services, which is basically the big organization that looks, after all, the health service in the problems of Alberta. So I'm way over on the right hand side of that photo behind the senior medical director for surgery. For the problems on we spend most of our time. It's about 0.4 point five of my time trying to figure out how we improve surgical care for a population of about five million people. So when I hear people talking about it, I mean, it's response times on long waiting listen, surgery and problem with complications and quality and that sort of thing in Northern Ireland. That's exactly the same sort of thing that that we're working on, Um, back in Canada, Um, as you know that what the moment I am on sabbatical. So it's a time to kind of relax and refresh on gonna re re focus a Z Well, so it's It's been interesting, actually, I've got I could have got a colleague who's covering a practice for maybe about a locum doing the clinical part of my practice. I've got somebody covering the administrative stuff in the research stuff, So I think when I left Canada, there were something like 13 different people who took over the various responsibilities that I have gathered up over the years, so I'm probably something of a bit of Ah, responsibility. Who ordered my wife says I'm the and the boy you can't see. No, I suspect when I come back from sabbatical, probably be dropping a few of those things so that I can read, refill precip it. One of the things I wanted to mention is one of the reasons why I'm here is we're actually doing a little study, looking at what's happening with the foundation of the medical school, and you probably got this email a couple of days ago. So this is this is me doing this. It's an interview on Zoom and then a follow up email. So there's announcement on the blackboard system with the text, my cell phone on it. And also the meal is well, so if anybody's interested in that, you could just drop me a line. Um, so I guess if I look back at the last what, 25 years or so, um, I think the journey that I have been known turned out to be a bit more exciting than I had anticipated. If you had said to me that I was going to end up in Canada doing all these things and being a professor of surgery, I would not have believed you at all. I would have said you're completely nuts. Um, so where I ended up was not where I was expecting to go. I do feel very lucky, actually, in very privileged that so many opportunities came along and so many things that, you know, somebody said, Would you like to do this? And generally, um, answer was yes. Um, would you consider going to Canada for a fellowship? Would you think about staying on for a job? But you'd like to do a pft, Which would you consider doing a masters and education? Generally, I just said yes because they sounded those things signed it interesting and exciting. I'm astonished when I look back out, but the range people that I've met on all the different sorts of work that I that I've done both in the education site in the leadership side, I find myself like I like asking big questions like what would happen if we did vest or what happened if we bridge into system. So we did that instead. As you can see from all the photographs that I mean, I tend to like bringing large groups of people together to kind of get stuff done, actually, and that's both on the education site. And then later on, without now, Bert Health services. So, um, what about my advice to you? So I would say like me. Uh, don't be surprised if your career doesn't quite go in exactly the same direction that you were thinking off. You might have unidentifiable what you're thinking of doing at the moment. That's probably likely to change quite dramatically over the course of medical school, so I wouldn't get yourself locked into exactly what you want to do right this second, because there's a lot of water that's gonna flu under the bridge. Other piece of advice is don't panic. You do have time. Um, you should actually in in in enjoyment ical school on, actually, take take the time to make friendships on support your car legs and get to know people because you don't have have to rush through. So it may sound strange, but I would say try to enjoy the experience is you're going through it. Um, you know, block a bidet, right? About mixing memories while you're in medical school, you don't have to be a doctor right this second. Also, don't don't panic so much about surgery. It's not actually quite a scary as you might you might think. I remember. I think it was Terrier one who used to be a surgeon at the City hospital when I worked there, and he used to say, It's that what is a surgeon? A surgeon is just a physician in the office to operate, and same is, Allison said. The number of days that were in the operating theater, it's only a few days per month. The rest of the time we're out and we're doing normal things, like all the other doctors. So it just happens that instead of prescribing, I don't know pills or chemotherapy or radiation or something. We happen to be in the operating theater doing the therapeutic side of surgery. So it it it doesn't make us totally different from all the other physicians. I would agree with Allison that the big secret I think about surgery is the operating is actually the easy part on. I don't think in 25 years I've met a single person who could not be trained to do the surgeries I've certainly had. If it's medical students come up and say, Doctor White, can you look at my hands and tell me are the good enough to do surgery? And it's really not like that at all. If you've got two hands on a basic level off dexterity, you can probably be a be a surgeon. I certainly think the hard part of all this is the decision making. It's a deciding who needs surgery and who doesn't when that surgery is going to be on, then how you manage things afterwards and how you manage some of the complications that will inevitably a arise. You are a doctor first. You're not just a technician. Certainly I've heard had questions about, you know, do you spend all day just sitting on the operating room in the wheel people and you never talked to anybody. When they're awake way, the job requires you to have compassion. It requires you to be very good at communicating on explaining things to people, especially when you're trying to explain to somebody why they might need surgery and get informed consent from them so that they understand exactly what they're getting into. Um I also think surgeons are some of the most reflective people. You will. You will meet because you're reflecting on the decisions that you took. You're trying to figure out what your limitations are. You're trying to say they just contact general surgery of rescuing people if you do have a complication but a recognized early and do something about it instead of living in the state of denial. And obviously you want to be able to figure out how do I get my practice to a point where I'm safe, happy with things and on the complication levels are are are minimized. So my answer to the question Why did I become a surgeon? Is, um I think it for me, it's personal. I have an actual skill, like I know I'm good at something like, there are people in this world who are walking around because I operated on them on but went well and they and they got better. Um, so I think I quite like that, knowing that that that's my skill, that I'm I'm choosing to exercise. It's difficult. I met somebody I went to school with years and years ago, I met her many years after I'd left school and she said, I can't believe I heard you. You became a doctor But I can't believe you ended the surgery cause that's the most difficult thing. This is somebody who's just think she's on content or something nice. So her perception was, It's the most difficult thing you could possibly do on. I would agree it is. It's, it's challenging. Sometimes it's difficult, but it's also very rewarding as well. Like when somebody gets better and walks out of the place, you think, Yeah, that's really fantastic. So I like the fact that it's and you make a difference. You are useful. You make it big impact on patient's lives on there. Also, at least when you're a general surgery, there's a lot of variety. Every day is different, and the same is Allison. Now I'll do some abdominal surgery. I'll do some, you know, interact with surgery. I'll do some her nails to do some gold butters every single day and and my practice is different. I never I never get bored, which is pretty important. So, uh, why should you care about surgery? Why should you want to learn about surgery. Well, if your rate off off surgical careers about the same as ours in Canada about 10 or 15 people in your class about one in five will actually become surgeons. The biggest groups will be general surgery and orthopedics. But you probably have a couple of neurosurgeons, maybe a couple of heart surgeons. Maybe there's some eye surgeon, same anti folks, some urologist, some of the other ones as well. So you're actually sitting among some surgeons when you're in class. For those of you are going to be surgeons. A lot of you're going to be specialist. He'll work closely with people in surgical specialties. So cardiologists and cardiac surgeons or your urologists and neurosurgeons or gastroenterologist in general surgeons. So you need to know what surgeons actually do because your patient, you gonna go back and forth between the surgical side of care of the medical side of care. And then, of course, a lot of you're gonna come. Family doctors, you'll be sanding patient in for surgery and you're managing them after they've had the surgery. So it's really important to know about surgery. So you do need to know this stuff on to be honest is really not rocket scientist. Not that complicated. The last thing I wanted to point out is I made you a tiny URL eso tiny URL dot com forward slash you you surgery on This is a serious of sets off advice. They're all little short podcast, like 10 or 12 minutes each on their focused on how to get the most out of your surgery experience when you're in the hospital. So there's 12 tips for surgical students working on a team learning in the clinic. Learning in the operating room I've also got learning from your surgical case is present in your case to a surgeon how to do wardrobes and your surgery patients on. Then there's there's really good one called How to Avoid fainting in the You Are buying a friend of mine called called Tummy Morris. So as it's a tiny URL forward slash year, your surgery. So that is the end of my slight. What I'm gonna do, I'm gonna stop sharing for a second on. Then I'm gonna pull up. We've got about 20 minutes left for a question, so I'm going to pull up the mental meter here. Onda Ah, I'll make it big so everybody can see So you should be able to see this. It says you could do this on your phone or your laptop or whatever you want. Um, good mentally dot com and you type in the little code on the bottom. Uh, which is 56 94 46 91. And this is our kind of task question. Uh, this is not high Far. Do you wish you Communities Day? How far do you actually communicates? Day. And this is just to get people on me, never to to make sure they're logged into mental. And that kind of answer, How far do I Communities Day? Uh, actually, I tried to ride my bike most days to work. So normally my right to work is about 21 minutes, so I'm going to put it in the tend to 30 country. So I'm going to leave that up for another minute or so. Let me. But they get logged in again. If you're having trouble, it's at the top. Menti, don't calm on, then. 56 94 46 91. I'll give you another 10 seconds or so lot a lot of people living pretty close to work. That's pretty good. Well, okay, I'm going to go to the real question. I So for the rest of our time here, I think the surgery side is gonna moderate. That's a little bit. We're just going to get you to ask us questions about surgery on the nice thing about mental meter, as you know, is it's anonymous. Eso your name's not associated with any of the questions. Um, the little box will come up there and then it just says, uh um, submit. So just take your protect your question in the box hit submit. It will turn up on, uh, on the screen on. Do you can submit multiple times if you want to. Last 10 different questions. So I think aloud. What did you want? A moderate The discussions. I'm actually moderate in this part. Professor White go through for you here, So thank you so much. That was amazing. Both miss like a break on profit. Right? So we're just going to start either obvious if you prefer to take one question for the other. So our first question is, how do you build? Find the work, life, balance of surgery. So we'll maybe start with Ms make you breathe. Yeah, this question gets out of a lot. Actually, I think it depends on what you want out of your life on line of work. It's going to look different for everybody, but, um But what I will say as I got to the end of my training wondered where the rest of my life had gone. So don't do that. It can be very consuming. And you do get caught up with a lot of work. And actually, do you know what? The destination is? The same. So I think you work out what's important to you, what you want your life to look at. There's lots of different ways getting to museum destinations of people. Maybe we'll work less until time or tree and less than full time. Sometimes they're partners will take on some of the load if they want to have a family. And my work life balance is much better. And I'm a consultant. Actually, um, I have a lot more free time That I did was a trainee, and I don't think I bounced up awfully well when I was a trainee. I did a lot of work and not a lot else did with that. Helps. Thank you so much. What about yourself, Professor? Weight? Ah, yeah. I think it definitely gets better when you're right of training. I mean, I trained him. What would be the old system? So when I started, uh, we were on and we were on couple every second night. And then as time went on, it was every third night or occasionally every fourth night. Um, a lot of that was actually resident in the hospital. So, you know, you were tired when you got home after being a being up all night in the hospital, and you were exhausted and grumpy. Sometimes I I think as as I got more senior, there was less and less of that on diets acting really good. But I think the important thing I would point out is that, uh, it doesn't just happen by magic. This balance thing on, if you're going to say that that work is important, you've also got to say certain aspects of your life are are important as well. So you've got to take time to exercise. You got to take time to spend with your family. You got icy, have some hobbies, interests and things that you like doing because if you don't have those that works, just gonna eat, eat every other part of your life. So I think you have to be better. Better than I was Probably when I was training, actually having some bone degrees and saying, No, these are This is the part of my life that's for me on Dwork doesn't doesn't come in. They're actually, um I think it's very to just be work, work, work the whole time, you know? Absolutely. What about you? How do you find started on your feet all day? Either of you, for that question, and when you're operating when you're actually the operator, you don't notice the time. I have to say, I would say that I could do, uh, 3.5 are a lot more on me and I'll notice the time. Know whether it's boring for other people in the reminder? No idea. It might be one of the interactive vaccines I take forever. Um, but you dio it's just practice, I think I mean, I did just it was interesting there was the podcast. Try not to phantom the O. R. I have come close to finishing on a few times, and even I was quite a senior trainee. Um, do you eat breakfast before you go in? That would be my chips. Um, on if you do, you feel about 15 to tell somebody. Don't just cope with it. But you did get you get used to say, if you're the actual, um, do in the operating room, you tend not to notice the time. Yeah, I I would agree. I remember when I was in cardiac surgery, I had I wasn't involved in the operation at all. I think I was supposed to squirt some saline, one of these hands where they would die, and that's once what once in a while, and I was really, really bored. And I thought I would need to pee here like I got to leave the operating room so I can pee because I wasn't involved in the operation at all, and I was just bored. I was. Every minute was a real drag. Whenever you started assisting, like actively assessing with surgery on, then, when you started learning how to do it yourself, then when you, when you actually were personally, was operating on, then later on the person who's training somebody else to operate. You're totally absorbed in the task, so I don't have any. Sometimes I could be in the operating room for seven or eight hours on. I'm kind of shocked. Somebody says, Do you want to go to the bathroom? And I'm like, No, particularly I'm I'm kind of in the middle of this thing. I I think probably if you're getting into a situation where you're heading, the fourth are on the operating room. You're not finishing. Sometimes it's better just to say everybody, let's stop for a minute. Put it, James, over the patient and let's let's all go and have a have a cup of tea for for 10 minutes on dust. Take a bio break because I think you are. You are human. You have a body that breaks down sometimes, and you're not made of steel or stone like you've got. You've got a admit to the fact that you do get tired sometimes brilliant. The next question is, do you feel that being a surgeon or have a career in surgery Coming mileage alongside having a fun place. Maybe start with yourself there. Professor White for that one. Yes, I would say 100% on the reason why. I say that is because I've got when I started and kind of actually, there were, I think nine of us and we were all man. And then over the years, we actually have hard on additional four women into the group. So about a third of the group, almost is, is women. I, um I'm thinking about for NASA. I'm thinking about Danna. I'm thinking about Leah, Big and about Bonnie. A three of my female colleagues have kids on me. Manage it perfectly well. So they all took maternity leave. They took six months or a year off in order to have their Children on. Some of them done it two or three times over the years. And they just got a local meant to fill in for them. And it worked really well, actually on then they've got me inferences. My colleague Dana sometimes gets me to see her patients on a Thursday because that's that's a day she say some weather with her kids. Actually. So, um I mean, she she she's really made it, made it work very easily, and it actually made it easier for me because I'm the first person the group to take a sabbatical. It was easy for me arrange because the women had had done it. First. Women had gone off and have maternity leave on had made it normal to be able to take a break at some point in your career. So I I think I mean, it's it's it's you're all of the start of your career, but you have to realize this is not a sprint. It's a marathon. So you may want to take a break or six months or a year of additional training or a fellowship for a degree or something, or some time out or sabbatical later on to do things that are important to you. The worst thing in the world would just be the like, work like a dog, train your ass off and then work for 30 or 40 years and never take a break. So I think that's actually very manageable. Toe do surgery on have a family, but I'll be interested to see what what Alison says s so I would agree, Actually, not from personal experience, so I don't have any kids or anything. But I do see a colleague. So you have had family is not actually interestingly attending it. We'll do it for the women and surgery of that every year. Please. On. It was one year that I think it was fine was talking, and I was the only one who didn't have any kids or husband. So it's like it's very doable and your life just might look a little different. Some of them work less than full time, something little longer to get where they are, but you definitely can do it. Anybody tell you, come to brilliant on what you find is the most challenging part of being a surgeon. Misspoke you bring, and sometimes the decision making a bite. You know, there's the old adage that a good surgeon knows how to operate a great surgeon. Does window operate on the best? Surgeons know when not to operate, letting us very tricky. Sometimes an operation is not always the best, Um, complications. It's very hard not to statement personally. We all know they happen. We'll get told that if you don't have any complications, you know, operating enough. But it's very hard, not Teo. Take it to heart. Um, I feel a but responsible for that, but that's where having good colleagues comes in. Actually, you can give you that support through that because they will be in there is well and sometimes you just need got more support on the other side of the table, and that's what I find quite challenging. What I I would agree about the mean. Probably the patients that I remember the best are the ones who really, really wanted me to operate on them on. But I really wanted to try to help thumb, but I realized that it would not work at all on Decanter was too big and it would not come out on. Do you just be operating for the sake of something to do? And it's very difficult to have those conversations and say, I really think I can't do this for you, you know, because you really want to be able to help. But in fact, you know when your heart of hearts it exactly the wrong thing to do, and you really shouldn't do that. So I think for me, it's It's that it's that decision making on the same know sometimes is, uh, is the hardest part. Um, I think that that's why I mean, I I've talked to about the group that I worked with in Canada a bit on I. The way I feel about them is there, like my brothers and my sisters, like, they backed me up. Um, so if I've got a difficult situation that I'm in or an operation is not going very well, I can I can phone over to the next leader and say, Hey, Don or a Dana or Hey, Mike, do you want to come in and take a look at this on? But it's it's much different than just being on your own the whole time, like being part of a team been part of a family like that. It's actually really, really helpful. And I bet your Alesse got got the same experience in Korean. Perfect. Um, another question here. Can you overcome Hajek overcome being a little bit squeamish. And, uh, since winter, Alison and you know, I never was particularly squeamish. Um, probably just a sort of limited exposure and just spending some time in the operating theater of getting you said, There is a very different place. I think we forget that because we spend a lot of time in there into office. It's normal. But you know, especially as students you go in. And it it's about hall to consume l. A bit weird, and there's diathermy, and it's just all about overwhelming. But, you know, if you just keep keep coming back, I think up that generally helps. Obviously, if you really hit the side of the blood, you're probably on their own specialty. That's great. Does it take longer to train for different specialties of passed this metal? Virtuality? Think. Is she still working here in the Northwest? You might have a better idea. And no all training, conflates and surgery. Look see him. They just you just working it in a different specialty. But a lady, even like trauma north pixie anti plastics, higher surgical training is you know it's still a core training. You still do you two years courtroom in, and then you split of ST three. But it's still six years higher Surgical training, regardless of which specialty going to some of them, could be more difficult to get jobs and and certainly plastics was one of those. I mean, I have colleagues who were my class minutes who were still registrars when I've been a consultant for five or six years so you can take a little bit longer to get into training for some some of the smaller special days that are more competitive. Her effect? Um, no, this is a question. It's come up quite a bit. What will be expected for most on our surgical placement of again? How Passover to Allison here Because she's acting one of the hospitals that will be out in placement. Actually, your yes, um, generally far students. Um, so I can talk about what we do for quitting students, necessarily. We'll do something similar with your cells, and we generally give you a time table of places to be spread your among among us. See? Gets, you know, to know all of us are six of us need it. Um, I'm the only guard. Um, So some of you will be on the war dryness in the morning, which is some bone surgeon. The waitress easily. If the patient is on the ward, you might find I patient clinic and sit in with either ms itself on registrar come to come to the operating theater coming down and office copay. And we we get you to scrub in at some point in the theater because get an issue for saying if you're a bit more bold rather than standing Bach, it can be good for you. Plus, you can see a little bit more, but it's going on. Um, there'll be cases that you need to do in presented just just only she turned out like a cheesy aspects don't text on or drawing to, generally helping. Perfect. And this is this along similar billion of what stage entry and we'll be able to join a men in any aspect and surgery. Maybe I could take that, Um, which is to say, Ah, I think we we want to get you integrated into the work of the surgical team as soon as humanly possible. Like if you're there on you've been running on the patients on the ward. Maybe you've seen paste in clinic and you've been the colonoscopy and stuff, and you've seen through, um, we don't want you to be a tourist like we don't want you to be standing on the corner of the operating room looking from 16 ft away, wondering what's going on. We want you to actually be in the team on describing Andi, be right there. So I can kind of had you on a panics and say, Well, this is what the panics looks like. Or I can say I'm gonna take your hand and put it inside the patient. Nine. You can figure out the liver feels like this with Spain, things like, Well, here's what a gold better feels like with some stone tongue inside it that the most common question I get asked, and Canada by medical student says, Is it Is it okay for me to scrub in on the answer that I give is? Yes, Absolutely. Like if you don't scrub in during your surgery course, when are you going to do it? Like so my advice is basically, you should be joining in as part of the team pretty much from from day one. I'm trying to say See as much on Go do is much as you can. Okay? You're not a doctor yet. You're still just a medical student. You're a junior member of the team, but you should be trying to get a much of the experiences you as you can. Brilliant. And then this is for people to be a walk is your favorite type of surgery to perform. So, Allison first, um, well, my favor operation is a leper. Stopping right hemicolectomy. It's a beautiful operation on I do like for sculpted surgery and, you know, it's just a It's a bit more challenging them. Um, enjoy us. That's definitely my favorite operation, Right? Uh, I would say this is this is a bit of a knob. Answer. Actually, I get a lot of satisfaction from being a really horrible goal. Better. Well, I mean, some of the gold better sweeping and editor, where I work are just really, really horrible on Maybe takes. You have a couple of hours, two car, but I do all the inflammatory tissue, but you finally got it and you can see that the cystic duct in the cystic artery and you're happy with the whole thing. I mean, you sweat on, but like you really pay the price for cases like that. But that's that's that's what I get the most satisfaction from currently. Brilliant were just coming in the last few minutes here. She would just take a few more. Um, what about tips on improving manual dexterity with one of us? Want to take that one? Uh huh. I will say, uh, 22 tips. Um, PlayStation, Nintendo switch Xbox 3. 60. Oh, good trainers. You know, because you're getting your hands right on the more and more surgeries laparoscopic. The other thing is, uh, go to the theater, get some old expired structure on. Just learn, learn to tie with your hands. I mean, when we were on call, sometimes the handles on the drawers and the on call room were just covered in knots. Because people have spent are just tired knocks all night long when they were on call. So those are the things that I did, and I'm I'm a big video game player, as you can probably tell. Brilliant. This one for Alice and hard, like, you know what specialty to cheese. When she knew you wanted to do surgery, eso um I decided to correct the line Was a first year regimen worked. Don't like Galvin with the surgeon cold Robert Gilleland. Um, he was colorectal surgeon on he. I like to tease him that he's singularly that responsible for May put in colorectal is especially because, actually, when I declared my subspecialty the Renew other women in colorectal surgery in Northern Ireland's So Everybody Was like You sure you want students very hard specialty for a woman? Um, but I think the range of conditions, the trait, there's benign conditions, ligament conditions. There's minor stuff, like hemorrhoids, specials, specialists on be more major stuff, the counselor sections, inflammatory bowel disease. I do some pelvic floor work as well. So I see ladies who have fecal incontinence or obstructive defecation. Rectal prolapse is so there's really white variety of stuff that we treat that also, I really like the surgery. It's really on a told Michael, and you kind of take a bit like back to back together again. I just It just really interested may wear a PSA done. A lot of breast surgery is more junior training, and that just really didn't nothing for me at all. It's just like coming coming out. Big lumps of fact, I didn't I just didn't just didn't appeal to me where is it working in the abdomen does. So that's why I chose some perfect word. Eight o'clock, you know, but I might just take one or two more crashes. That that's okay with you both moved some interesting ones here in terms of getting involved in research into something you mentioned is getting the head in terms of getting a place on the surgical training program. Five. A big old bike that is medical students. Well, you know, fast first hospital X. I don't do an awful lot of research, like I know that there is up this stuff starts urge that I mentioned, um, that's generally don't I think, three, The medical school. And there's a society that those that, um, smaller project she can get involved in in the wards that you're attached to. Um, if you're seeing, come in, ask, there's any projects that anybody wants done. Even old apps, apology and movement. All of that. Kind of So, you know, we again like to see people get involved in their stuff that we can always find you projects to do while you're with us. Brilliant profit. This one's for you. Any talk tips for learning in that on me? Something we're struggling with the moment? Yeah, I I think I I find it very difficult learned. I mean, we did cataract this action of queens back, back in the day, right? And then we use grants, grants, anatomy and grants to sector and all that kind of stuff. And it was very hard to get a stick in your head there relationship, the cavernous Sinus and all that stuff. Um, I for me It clicked when I think was the book bag I called Harold Alice called Clinical Anatomy, which made everything relevant to clinical problems. The patient comes with this problem and the reason why you needed the anatomy. Is this so? I mean, I probably know the boundaries of the femoral ring because I read and Harrell Ellis Clinical anatomy. So I think if I can, my advice to you is don't just learn, like, cold anatomy, because it doesn't make any sense year. I mean, we learn your own and, um, you know, as a medical student, that is completely gone from my at night because I've got no reason to have it. But if you can stick that knowledge under clinical story and say, Well, I need to know this because this is how the ankle gets broken sometimes. Or here's where are the It comes out or here for somebody gets stabbed or something, then that clinical knowledge is really important for making the anatomy stick in your hand. That's really helpful. Advice. This next one here is for um, Allison, that there's two kind of questions about this is a less than full time career and surgery feasible. And also as a woman I'm scared that having a family needed Motrin Aleve would leave me behind my college scale weight. Is this true on how you people overcome this from your experience? Yes, less until time training is basically all. Actually, Mister Good Wanna only cold is actually our our training program director for surgery. And then he'd put weight on sit up. But yes, it is. I mean, I know some of the trainees air less than a little time because of their family commitments, and so it's certainly possible of us. It takes you long, slightly longer, although that may actually get clothes back a bit because the way that we assess people during their training is changing and it's like competency based rather than time best. So when she had your competencies, then and you could be signed off, you know? So you're like you're looking. We're looking for people here, Comma, don't become a day one consultant on It's much more competency based on I for the maternity leave and leaving you behind your colleagues will. You know, if you do take time, I'll see you're gonna Your training's want to extend, and there's no getting away from that. But you know, I lots of my colleagues have kids during their training, and, you know, your training years coincide with your child bearing years. There's no you know, it's just the way that it is S O. Yes, you'll fall behind, and that you might not still be in the same year is your calling She started with. But there's absolutely no reason why you picked those skills up again, AM and move forward, and especially with competency based trailing, that's going to become slightly last initial, So I wouldn't I wouldn't be scared, but you know it's it. Women have babies. They just have to get over it. So just last two questions here, so this one is for profit White looking at UK versus Canada Terms of specialize out, a specialization and healthcare system Overall. Biggest difference. It's actually fairly similar because the people who populated the least problems of Alberta many of thumb came from England and Scotland. Ireland systems actually quite similar. Probably the biggest difference is that I would notice one would be that the surgical training that I did was 12 years long. But the surgical training that my rest of the story is only five years long, so it's a much more intense experience on at the end. You're you're chief resident, and it's a really intense year when you're doing your operating pretty much all the time. So at least in the UK, it's a bit more spread out. But for residents in Canada, it's a bit more intense. Thea other thing is that we are We're paid in a different way, so we're not salary based. We're actually paid by the by the case that we do so basically, if you do four honey is in today you make twice A smart money is if you do two hernias in a day, so I think that actually that that speeds things up a lot. Um, because there's a really pressure to get people into the system and get their operation done. Get the mode again so that more people can can come in. We do have problems with waiting list, but nobody waits for, you know, 18 months or two years for a surgeon. My current weight loss is something like six weeks or something with the with my with my local. So I think that the way that the system is set up definitely changes how people practice brilliant and last question here for Ms Makuhari, you have any tips for learning to be more calm, slash two sites up under pressure and get calls with experience. Um, I'm just having spent time on the job in with, you know, over seven year your training. There's always somebody else to ask. I think never forget that we're old headed to be on call. I know people. Oh, my goodness. I can't call a consultant or Kunkle. I'm paid to be on call. I'm paid to take your call it three. In the morning. If you're not sure what's doing with the patient, you know, always remember the patients more scared than New York. Okay, so you learn to hide up a little because there are still situations that do for you Sign a little bit. Um, certainly massive Upper gi I blades never make me feel very helping. Um, but I've always been a little I'm a little bit of a swollen where I look for a calm the right side, but my feet are going 22 the dolls and under the water. And but a lot of it will come with experience in time, watching high your seniors day with things and high. They manage situations is a big part of of high. You learn how to do that, too. Definitely. I would agree it. I think it's a little bit like military training. Um, I mean, when I was on call in the early years, when I was a register, our I used to worry about what would come through the door on. Then, as time went on, my wife actually said, You don't seem to be so nervous tonight. You don't seem to be so worried. And I realize that I had seen everything at least once. I had done most operations at least once. I kind of knew what would come come in the door on by realized then when I got into practice that my training was really, really good, Like the people who had prepared me for this really had build into me what I'm supposed to do. So when you're training just kicks in, you're not worried and you're not scared. You just say this is what I do and this is what I do And then this's what I do. I was talking to one of my colleagues recently. You I actually helped train him, and then he became my my colleague on by was sitting in there or lunch one day on day. He came in on Saturday beside me and he said, I can't quite believe it said I've done my first liver resection and I said right, and he said, you know, because I trained, they did the fellowship and everything and you know, But up until now, I I'd always have somebody there that kind of hold my hand on. Today was the first day that I was totally on my own with my team doing. I was leading the team on. I did it and it went really well. So he said, I've realized my training worked. I am not a highly trained surgeon, and I can start to figure out where I go next with this. But so I just say trust, trust your training. Absolutely. I had a similar situation when I my very first operating list. I worked in old big elephant, actually with Mister Good wanna when I was standing up. But this side of the patient was doing a lot, right? Hemi Onda. I suddenly realized that I get and I have never done one with a consultant scrubbed because it was just the way it was. We didn't have a lot of yourself, so I was like, Oh my goodness. Oh, no, I I am the consultant. Oh, I'll Here we go on it went up. So you find on your your training just kicks in and you just do it. But there is that kind of realization when you're like, Oh, right now I'm the boss. Okay, but let's go and see what happens. But you have been treated. They wouldn't have let you finish if they didn't think you're ready to go. That's brilliant. we didn't get a chance to get through all the questions, but it's gone. Just the bird. 10 minutes over time here. So thank you both so much I'm gonna handle overturned Michael to close on. Just a swell everyone. Doctor Harrison. Professor Deborah put some information rather been told, you know, virtually specifically in the chat there they came up related to the passion that he's want to have a look at that. Thanks. Yeah, I don't want to take them too much of anyone's time, but just once a about for the society and all the attendees. A massive thank you too, Mr Cranberry on Professor White. And because being really inspiring to hear your your career stories and then your journeys through training. And but it's it's really it's really appropriate for us to the society to have your investment. And that's an early days and on, uh, I really hope that you'll come back and share more of your scales. More of your experience with the PSAs. We host our our future events. So and that's a massive funky again for coming along and stigmatise, thank you very much. Still the attendees as well. I mean, No, your time is ready. Valuable at the moment with with exams a few weeks ago. Soup mover. Very mindful of just keeping this a short introduction and on something that would be a pill that you could check into from home. So really appreciate your support in the society's first of it found Suppose, and we're really wanted to get something in in the first year. But I suppose in the future, events look look similar to this and hopefully in person, um, more local surgeons and be hearing from different specialty. So by all means and nickel has said that feedback form so pleased you fill that out and tell us what you want, what you want to learn. And and he you will hear from what's special days you might like inside into, um, on a swells talks. You know, we'll we'll hope to run things like scale, sessions, things like theater at a kit. You know, just there's little things that really prepare us for for your placements in four years. And so, yes, it's the muscles. Think you for your support messages on this first event on again, Ms MC agree. And Crestor, right? Thank you so much. Thanks. All right. Everyone is looking for your evening back. Have a good night. Thank you very much. So you better?