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Good evening everyone. It's nice to see everyone. I was going through the chat today. Uh And uh I think uh we sent out a few messages on social media. It's very nice to see everyone tonight. Uh I hope you enjoy tonight's event. And uh I think a few of you being up in the poster hall and be posting about the poster hall, which is fantastic. I can't wait to check all of the amazing posters. So, uh this evening, guys, we are going to start and commence R I B M C surgery conference and we are delighted for all the speakers that are going to join us in the first half of the talk. We are going to have Dr Dafydd Lokeren or Mr Doc Doctrine. He is now in his very own healthcare startup, probably a bit beyond that. And then later on, we've got Ryan Kirsten who's a consultant, plastic surgeon. Um And uh we will have both of them talking back back after each other. Uh Straightaway. Uh So if you have any questions, please save them afterwards. Um So I'll give a little bit of an interruption for Daffy. Daffy is the Chief Executive Officer at Concentric Health and is also a NHS clinical entrepreneur for the NHS England. Uh He is a surgeon by training, he's complete course surgical training and then went on to uh uh work in med tech and health tech. And he stepped away from his spr training in 2016. And he's been involved in, in trinity worship within the NHS and he said teams at uh tech unicorn and he's now delivering the marketing and leading digital consent application uh within uh within the NHS at the moment. So um it's a small connected that team. Thank you so much for joining us today. Doctor. I will hand it over to you. Amazing. Thank you so much for here for the kind words. So um what we're gonna do between Ryan and I, so Ryan will join in 20 minutes or so is to try and give a bit of a flavor of in what innovation can look like in, in the space, in the kind of surgical space. I'm going to share a little bit of my journey and kind of reflections of having done innovation in a, in a few different places and with a few different hats, kind of what some of those reflections are and, and then we're gonna step through to Ryan and who will take that forward. He's got roles as you know, the Royal College of Surgeons, as technologist and these kind of things. So he has a really great feeling of, you know, what are the themes and that are coalescing around kind of digital health and surgery and what does the future of surgery look like? And so as you said, paying a load of questions in and, you know, hopefully there's a, there's an opportunity to just, just reflect together as a group on, on where, you know, on these journeys and where that's taking us. So my story and so I was a surgical trainee in, in Wales. So I did my uh medical in Cardiff Foundation training and core training in, in, in Wales, both in South Wales and North Wales. And I'm from a kind of reasonably techie family. And so it was no surprise that in my foundation years, I found myself kind of playing around with lots of different things, um mainly through frustration. So, you know, little things, you know, on the wards or, you know, that I just felt frustrating, felt annoying. And, and so my usual kind of, and approach to that was to try and uh see if there was some simple solutions that I could, um uh to do just basically for my own, for my own use and for my own sanity. And so as a kind of foundation doc I would start and, you know, I, I ended up building a few web applications and little things that I would use and one of them, which kind of becomes more relevant going down in, you know, down the journey was a consent aide memoire. So uh there was kind of one correct moment as, as an F two. So I know we've got international audience. So that's gonna second year postgraduate where I was told, right, you're, you know, on this, on this firm, your job is to get the consent from all the patient's. So, you know, go through, go through that consent form and get their consent perceived with the operation. And I knew very little about orthopedics and that seemed a bit crazy that I was having these conversations with patient. So I basically didn't know what I was meant to be talking to patients about what those kind of risks were, what the outcomes were. And so I started building something for my own use, um that I could just, you know, remind myself before having those conversations about those kind of key things. And basically from there and that was a kind of first kind of teeny little step into innovation. It wasn't kind of and it wasn't kind of on purpose, it wasn't explicit, it wasn't kind of me trying to do innovation, it was just me trying to kind of solve this problem that I uh that was annoying me. And over the next kind of year or two when I go from hospital to hospital, people would be saying, oh, you know, before, before you go and you know, consent, a patient for a certain procedure, what you're doing on your phone. And actually, even though that was only 2012 2013, even at that point, you know, it's not that long ago, but it was quite unusual that you had kind of Mobil's out and people would be like, should you have your phone out? You know, and things of things have definitely changed in that respect. But from that quite organically, quite a few people would start using this application that I had kind of built and um would add content onto that and um grew this bank of information about kind of risks of operations. And that led the kind of put a little bit of a seed of, it's kind of interesting and the the community around kind of clinical entrepreneurship. So, so kind of people who are clinicians who are doing something a bit unusual or something slightly different to the to the normal clinical training pathways. And that community was so small at that time that if you were doing anything at all, kind of everyone knew, knew each other and, and you have lots of opportunities from that, you know, going in pitching at startup schools and, you know, all sorts of various things. And so two years down the line in 2015 2016, as I was finishing core training and going into ST three as a as an early neurology registrar. I was kind of curious enough to say, well, what if I don't do the kind of normal training pathway. What does that look like? And most people in that scenario don't really know what that could look like. And I had some pretty tough conversations with training program directors, education supervisors, that kind of consultants who are meant to be kind of supporting me along that path. And, you know, that was very much along the lines of, you know, what are you doing? Why on earth you thinking of, you know, you've done your mrcs, you're gonna initially surgical exams, you know, this is the path you're on. Don't be crazy, don't throw this away, you know, and all that kind of stuff. And so I kind of stopped having those conversations because they weren't that productive. And uh but I thought, well, there's enough of me, I'm kind of curious enough, I'm not put off by those conversations. I want to explore this a little bit. I wasn't brave enough to say, right, I'm going to go and join a startup and I'm gonna kind of jump in and do this. So I am did one of these kind of sidesteps. So I did something that's kind of available in the, in the UK, which is called a leadership fellowship. So a year and it kind of still within the NHS but slightly outside of programs. So you might sit in, in a kind of innovation type role or a quality improvement type role and, and, and learn about kind of leadership and that kind of stuff. So I did that for you for a year and was given a huge amount of and space and freedom to explore. So I sat down on that first Wednesday morning and with my education supervisor for that year and he was kind of, I'm kind of interested in what you do with a year of freedom and that was just an opportunity to do something completely different to what had been the previous year. So I did a lot of work within a quality improvement hub. I did, you know, lots of supporting lots of projects within the NHS. And then I also had an opportunity because of the kind of space I had uh to go and just sit and kind of watch and get involved with some startups and sense of time in London and that kind of stuff. And so as we go through this kind of step, what I want to do is just reflect on some of the kind of opportunities the pros and cons of doing things in different spaces. So if you think about that first step that, you know, me just solving a problem very organically growing out of that, um There's a lot of benefit to that, like you're super, super, super close to the problem and and often just by virtue of being within the organization within the kind of system, um there are a lot of opportunities from that. So a, you can learn superfast because you're so close to the problem and you've got really easy access to other people and other people kind of try your thing and they say, oh, can we do this and that? And it's, it's very easy to make sure that you're really on the right path and you quickly aware that something you might have built or, you know, started playing around with, you know, wouldn't work or, you know, it's missing this and that because you just can't get away from that. You're, you're so close to it. And then that next step where working with kind of project within the NHS. So that kind of um entrepreneurship and not on entrepreneurship, but kind of innovating but within an organization. And that's kind of turn sometimes used for that. And that's really interesting. So you are in some ways still close enough and kind of within the organization. So you've got the kind of context of, of why something might work, why something wouldn't get, it's quite easy to know who the right people to talk to, to try and get things to happen. And, but you're definitely hamstrung in terms of most of those setups don't have, you know, great development teams and, you know, data science and, and, and some of the things that these projects sometimes need. And so you can often say, well, yeah, this is exactly what we need to do. We've got good clarity of what we might want to do, but it's quite difficult to actually execute and, and, and do that stuff. So at the end of that year, I was approached by Babylon Health who are kind of reasonably controversial company, um, innovating in primary care initially. And some of you might have heard of Babylon, the kind of recently I P O in, in New York and I went to Babylon when they were still reasonably young. So they were kind of 80 people. And I was there for almost two years and in that time, you know, grew massively and, uh, you know, there were 800 people or so when I left almost two years later. And that was really interesting. So this is a digital health company and sat outside of the organization trying to disrupt the status quo really. And that comes with it, you know, it comes with its opportunities and its challenges. So, you know, first thing, first, I learned a huge amount during that process and just in terms of seeing, you know, an organization change, an organization grow and, you know, how you build a business. And I went into that role as a clinician. And two years later, I was still a clinician. I still am, I still think of myself as a clinician but had been exposed and had started learning some of the, the kind of nuts and bolts of, you know, how a business works and how you can you know, learn things from other sectors. So in that kind of digital health space, we actually see a huge amount of people coming from other industries into those kind of cool, fast growing digital health companies. And there's so many more of them now and, and that's a space that's exploding and there's just the huge demand for clinicians um to be involved in, in those kind of setups and, but you also learn from that. So, you know, lots of the people coming into those companies might have come from other uh you know, commercial companies, they might be, you know, coming from Etsy or coming from, you know, shops in that consent and they bring it, bring an attitude which is, you know, sometimes you have to challenge and you can say, well, does that really work in healthcare? Is that the right approach? But there are some things that you learned, say okay, you know, actually that's, that's the way you change, you know, you change behaviors and things that companies and commercial companies and course, you know, uh consumer brands are really good at making us do which often in healthcare, you know, changes really slow and really hard and it's, you know, everyone's kind of pushing against it. But some of those consumer brands that we all kind of let know and love and jump at and, you know, all use a day to day have cracked a lot of that kind of behavioral stuff so you can learn stuff from that. Um But there are definitely challenges and I, you know, saw it was quite interesting, kind of trying to do the right thing, but outside of the system, in quite a controversial company and so you kind of come up against the system and you hit the system and you spend a decent amount of time trying to kind of um you know, patch up issues or, and you know, trying not to be the bad guy and kind of finding ways to be useful without and kind of disrupting, you know, disrupting in the right amount and right way. And that's, that's always a challenge and finding that balance between being a kind of business and, and being a kind of a healthcare company who are trying to do healthcare, good things. And then I, so I then had the opportunity in early 2019 to go and take what had been that kind of side projects that bedroom project around consent and make it a real thing. So we got a reasonably sized and innovate UK grant, which is the kind of UK research and innovation grant body and funded us to, to go and make it a real thing. And there's a kind of an interesting story around perseverance there as well. So we had gone to innovate UK and ask for grant funding a couple of times and not, not got it. And then in 2018, we were back to them again with a, with a bigger grant, uh, with a slightly different focus. And innovate said to us, uh, no, uh, that you can't, you can't do that because you've, you've already applied twice and you didn't get the grant. So we can't look at it again. And so we kind of really pushed and kind of, you know, a decent amount of touring inferring and of trying to convince them that this was, you know, different enough that it wasn't just a re application and it had different scope and please do look at, look at this application and, and they agreed to do that and uh and we got that grant and that was a, you know, a huge change moment for us, you know, an email at half five on a Friday evening saying here's some money to go and take, what was this tiny little organic idea and something that very slowly grew out from in 2012 2013 and go and make it a real thing. And so two years down the road down the road, we and now the widest used digital concerns application in the UK and kind of increasing use internationally being used across lots of lots of NHS organisations by now and growing quite quickly. And, and that's, you know, been done in a quite a different kind of approach with a very small little tightly knit group. Again, this is kind of clinicians, developers and designers very clinically led and, and, you know, uh kind of trying my approach in terms of Concentric is to almost feel like we're inside the organization. I kind of like that feeling of being inside and the, the organization and feeling close, close enough and being able to kind of collaborate and innovate and, and feeling as if you're in the same team, you know, I want to be delivering a product and into an insurance organization where that organization thinks within the team and thinks, you know, yeah, I want dad to kind of, you know, the summer barbecue that kind of that kind of feel rather than us kind of selling in. And I think that's a much more kind of healthy approach for, for us and for our, for our kind of well being if from a, from a digital health team as well to feel that were part of that we're not just kind of hard selling and going in. And so, um that's my kind of, I'm going to hand over to Ryan in a moment or so, so what we're going to kind of explore with Ryan is going into, you know, what some of the themes are digital have and, and what the future of surgery looks like and then bring it back together for some Q and A to think about, you know, these journeys in the different pros and cons of innovating with different hats on. And as clinicians increasingly you know, you have lots of opportunities um available to you in terms of innovation, both within kind of traditional pathways in kind of halfway houses and also outside. So hopefully plenty of questions to kind of explore between Rhino, give it to you. So, data. That was fantastic. Thank you so much for sharing your, your story. Uh So I, I think we could probably pop on one question before uh Ryan comes through and um it was a really good question. Um So I'm going to scroll back up. Um So it was from Barry Beth. I hope I pronounced that correctly. It was finding the talk really interesting. How did you go about enrolling onto a leadership program? Uh And did you need to have any evidence of having a project idea implemented in advance of learning this? How would you advise someone looking to become involved in digital health? I think that's a, that's a pretty good question and key question for many people in their minds. Yeah. So, so there are a few of these leadership programs and a few that are slightly different, you know, we, we see more and more kind of digital health fellowships with initials organizations and there's, you know, there's some A I fellowships that have come out of more fields and, and things in the UK. And so there are more of these opportunities, some of those need a kind of an idea and something to go into and so things like the NHS Clinical Entrepreneur Program, you, you go there with an idea and that doesn't really necessarily mean that that's the, the idea that you go through and kind of work on over that year. But it, it shows that you've kind of thought about it and there's, uh you know, there's an opportunity to, to kind of quiz you and work through that idea with you and interview and that kind of stuff and it might well be the idea you go through. But, and you know, I would say there's, there, there are enough opportunities out there with diff slightly different focuses be that, you know, leadership management into digital health and to kind of change in quality improvement. And so hopefully there's, there, there are, you know, opportunities there in terms of getting involved in digital health. I think it's interesting. So there are, you know, so there are more and more kind of jobs out there. So if you go to Doctor Preneurs or, you know, there's quite a few Facebook groups around alternative careers medicine and, and these kind of things. And so there are jobs out there and they're across the spectrum. So some of those are, you know, senior conditions, but more and more of them are people who, you know, maybe have a little bit of experience medicine often have needed to do kind of med school, maybe some foundation years. Um but it's, it's not really the case that, you know, I mean, I remember being told quite often that, well, you know, get your, get your completion, you know, your C C T, your completion of training and then you can think about these other things and it's not really what we see in terms of lots of these jobs by now. But the other side of that is that, um, you know, these are, these are generally, there's a, there's a huge number of fast growing kind of little agile startups in this space and, and most of those kind of, you know, CEOS or founders or kind of whatever you want to call us, um Actually really happy to sit down, you kind of have a coffee, you know, remotely or in person and explore what you might be interested in and, and work through that. So we have a few, you know, elective students and that kind of stuff every year and, and so I kind of wouldn't ask for permission every time, you know, it's, it's kind of saying, reaching out saying love to kind of get involved. Most of us are still of that generation where actually lots of those opportunities weren't there. So we often got those kind of breaks by reaching out someone, seeing someone in conference, you know, whatever that was. So if you see companies that seem interesting that seem like they're doing something that you'd be interested in getting involved in. Um You don't need to be told you've got permission to do that. Just, just, just kind of reach out in terms of kind of junior doctors, medicines, like amazing kind of experience and do not underestimate that knowledge that you have as, as kind of medics and you know, trains and that kind of often you and we can in a split second tell if an idea is ago or not where others kind of not gonna versed in that might work on a project for months and months and months and work it up and think it's a great thing and then you come in and say it doesn't make sense. What are you getting? So there is a lot of value and definitely don't underestimate that. So I think that's fantastic guys. It's uh so I wouldn't, I wouldn't underestimate the coffee and asking a question. Uh And that is a lovely segue onto our next speaker. Uh is Mr Ryan Kirsten who's a consultant, plastic surgeon. Uh He's got a specialist interest in skin cancer. Uh He is the founder of Tourney Strip and he is also the technology edit er for the Royal College of Surgeons of England. And I did have a coffee with him at the asset uh um uh future surgery conference and he was absolutely lovely. So do not underestimate that and look where we meet again. All right. So without further a do Mr Kirsten, I'm going to hand it over to you. Please uh tell us about uh your, your journey. Excellent. Thank you very much. Let me just get, so I'm actually going to do something slightly different. Um So I'm going to follow on from what death was talking about and I know it would have been an amazing talk. I'm really sorry, definitely didn't quite make it for the start of it, but I know it would have been epic. Um I'm gonna look at um innovation from the kind of the point of view of the kind of surgeon. And you know, as you go along your career, actually, what, what is innovation and how can we, how can we innovate in surgery? So I will, I will save my journey for a uh the next time I get invited to come and talk hint, hint. So I think the first thing to say for my uh presentation about to give you is you're gonna need either your mobile phones or a or an extra tab open um up on the browsers. Uh And you need to go to slide oh dot com. Uh And the number, but don't worry, the number will come up again, but it's uh 518587. But as I say, it will come up again. Okay. So thank you for that super kind introduction. So my name Brian Care Team, I'm the plastic surgeon working in ST Mandible and Bucky. Um Share, I'm one of the uh like that one of the NHS question entrepreneur fellows. Uh I'm a massive massive gadget. You just love tech and gadget. Uh And it's that combination, which means that I've been really, really fortunate and been able to be the technology editors and writer for the Royal College insurgents uh bulletin germ. So I hope that over the next 15 or seven minutes, I'm going to kind of give you a good understanding of who innovates what innovation is, why innovate. And then the final bit on the magic of how. So we're gonna start with an innovation and in true NHS textile the last two times, I've given this talk, this a little bit of Pepsi has completely failed me. But as a, as a massive evangelist, I'm going to run with it again and just see if it works. So I'd like to get a sliding dot com put into the, put in the code and hopefully it should ask you who you think the most innovative companies or organizations are. And we'll see if anything changes in like three deaf. What you hear? Is it just cause you got yours I can hear. Is it coming up with, is it asking for any options? Uh Apple, Apple, Apple and Google, uh maybe uh There we go. Fantastic. Good, good to know massive surprises so far coming. Um uh Spotify, I would argue with as of today. They are definitely in my tech bad. But uh if anyone has been following Twitter, um Thank you for ever thinks that this slide uh code is innovative. Um But you can see that what we've got here are some of the big tech companies, Astrazeneca, really interesting choice Medal, of course, coming in twice. Um Good. So actually is a pretty good mix. Usually people just stop the kind of the tech stuff so you can keep adding it in and I'm happy to share what people think at the other end after this. So luckily, we, we know who the most innovative companies are and it doesn't need to be kind of doing slightly odd slide. Oh Polls in presentations, there is an organization called Fart Company and every year they release who they think are the most innovative companies. So not massive surprises. If you look at five of their top 10 Apple Netflix, Amazon, Uber, Facebook. So you look at that and go, that's really interesting, Ryan. But my in any way is that relevant to healthcare? Healthcare is a an older kind of organization. If you will, the Electrics, an old organization, these are all young agile startups like contemporary. Um the NHS can't be an innovator because it's healthcare. Oh, sorry, because it's old. And I would argue that that's not true. So Nintendo is 100 and 40 years old. So makes the NHS look like a spring chicken. Uh And they are there in the uh I think the top 15, the Washington Post, one of the oldest uh news publications in the world is now, those are tech minded will know that Jeff Bezos auto owns the Washington Post. So it's no massive surprise. Spacex new company but old industry that, that they've managed to completely revolutionise um satellite delivery and ultimately space travel. Um so old companies or organizations can innovate. So maybe there is hopefully in the NHS. But then your next commentary. That's great. Right? But it ain't just healthcare. You can't innovate in healthcare. So that's not true either. Um There's some amazing companies in the top 20 of the farts company, most innovative companies. So one home are looking at your, your genetics to work out whether your lights get side effects or be from certain drug trials and trying to streamline your selection into drug chars based on your genetics. Uh CVS is an American farmer pharmacy company like boots over here while all other us pharmacy companies are losing stores, they are growing stores because they're using lots of digital health tools for their customers to help rationalized medications and ensure everything is smooth. A live court powered the first Apple watches with E C G s and last time I checked, they powered over something like 30 million E C G s off the back of their, their watches and the vat test again. Old, old company and healthcare company with all the research I've been doing with Pennsylvania University on Carty. So we can have an, an older healthcare company as an innovator. Okay. So if that is the case, next slide, oh is what is innovation? So we we talk a lot about um that should good. Um So we talked about a lot about innovation and there's lots of talk to people with a little about healthcare innovation. So my question to you is what is innovation all but is healthcare innovation? What does that really mean? So, and this time I'll be patient. Hopefully as it worked last time it all went the nice creativity. I like it. Yeah, a new stuff that was me, get into the system worked earlier. Finding simple solutions. Yeah. Yeah, we'll come back to. That is a really good, good point. Progress. Um Natural selection, natural section is definitely an innovation. I love it. Um Advancements good. These are really great. Um So there's the question is what, how does, how is creativity different from innovation or how it's it's changed and innovation the same? So through outcomes? That's brilliant. And I'm gonna come back to that. Um So these are really, really good. Is it, are they truly a definition of what innovation is? So not again, it doesn't need me and slide oh To tell you what innovation. So M I T tell you this, that innovation is invention and the ability to commercialize it. Now, I am a massive uh public sector Fanboy. And so I'm not sure that when it comes to healthcare commercialization is actually the right term, I would say it's this innovation is invention and we'll come onto what each of these really mean times by the value that you can add. And the question of, is it possible? So what's uh what's inventions, inventions, these are kind of ideas and healthcare has got to be patient focused. Um Even if it's not delivered to the patient, you got to think broadly, how is this helping patient care? And it could be uh I think that helps train surgeons. Ultimately, it's still something that is going to help patients'. It's gonna be expertise driven that I either if you think VR is the future, again, talk to somebody that is involved in VR see what is really possible and don't just go. Oh well, the metaverse is where it is. So therefore, I'm gonna now pro by the metaverse into everything I do, it should be proactive as opposed to reactive value adds. Now, if, if there is one slide from this entire presentation for you to take home, it's this uh if you are elevating your healthcare, you're going to do one of two things. So either gonna improve outcome or you're going to reduce the cost to get there and then these can be prompted. So again, picking up that training idea, if you are training, if you've got a new way of training the next generation circles, then you're probably uh improving outcomes and reducing costs. Um But the truth is actually to really have a quantifiable improvement on health outcomes is difficult. Uh And two huge cost that is the driver that really come to uh finding new stakeholders, that you end up having to uh prove your worth too. And is it possible? So in order for innovation to be possible, you've got to have leads committed to it, you can't go, you can't get it into places if innovation is not, their priority is got to be cross functional. This is another key learning point for this talk is you cannot do everything on your own. You your kind of med students, trainees, surgeons, doctors, whatever it is, that's your area of expertise and you may know some tech on the side. But in order to really get something working, you need partners that can cross those different decisions. You have to, you have to measure it. It's gonna, you're gonna find the performance metrics. So is it really working? Are there things I can reiterate and improved and kind of taking learning from books like the lead start and just to reiterate, this is a team activity, you may have the first idea, but that's nothing. Uh In fact, there you go. So um these things take a long time, especially if it's in healthcare. So have any idea is right at the beginning of the journey. Okay. So what about this? Why should we innovate those, do we? Now we know that we can innovate. We know what innovation is but why do it? Well, historically, innovation was brought into the NHS for these reasons. You'd have a headline in the, in the newspaper and there'll be some pressure to address that headline uh to get MRT down or cut X amount from the NHS. And that was really what uh innovation was driving and I'm guilty of that. So Tony Strip, which is my first startup was or is a see where you stand okay that we developed because of the MRI Tea pop. And so this was back in 2004. So um this used to be what innovation was driven by, but now it's changed. Even NHS England, if you look on their website under innovation, it tells you that innovation is critical that it, we need to be ramp you up to improve the care that we deliver to deliver better outcomes. The NHS is the world's largest healthcare provider. So if we can nurture health innovation, we could essentially have a huge wealth creator in this country. You can feel this is not reactive. There are, there's now ground movements really change it. It's not just something that they kind of center the NHS. So here's two great reports. Obviously, I'm biased and would urge people to read the future of surgery reports. Um outlining kind of how surgery and healthcare is going to change in how we achieve those changes. And you've got organizations like NHS X trying to kind of maintain the strategy of that at the national level and this has been felt on the ground. So this is some hot off the press data that myself and a colleague are looking at. So this is looking at VR publications using the terms B R A R in surgery and you can see year on year it's increasing. Okay. So very briefly, let's talk to what are the exciting innovations are going on in surgery. So the first thing is probably around imaging virtuality and augmented reality. And by the way, these headings are what the future of surgery clumps it's innovations into. So I'm going to be teaching you to suck eggs on this one. I'm sure you all know. So reality, augmented reality, mixed reality, virtual reality. So reality is what we're getting is real life. Augmented reality is superimposing a digital image on your environment. The two things are not anchored to one another. You may see. Uh did you trade up in the air or whatever it is? But it's not related to what's in front of you. Mixed reality, actually take that digital images and thinkers it onto something. Um uh So as you move around, that digital image stays in place relative to what it is that showing you and that reality is been the opposite of actual reality is you're completely enclosed in the digital environment. Okay. So going through that spectrum, even reality is being augmented. So we over at Stoke are about to trial these head units. They are identifiable members, Google Glass, they're very similar. So it's a four K camera that wraps around the front of your eyes. Uh and it has a screen pointing backwards. So from our headsets, we can send the images of what we're doing to trainees in another room, in another country wherever and, and they can take screen grabs of that doodle on it or send images back and they put back onto a screen that we can see in front of us. So kind of borderline that second, it's borderline or reality, but equally, it's just, it's just showing yourself on the screen as a base really bedding into your environment. But even one transit areas, even bugs and the reality, there are things we can do uh augmented reality. So on the left is plate universities anatomy program where all the trainees stand around and there is a anatomical model that they all see in front of they can move it around in large heart, see the bell walk into the heart, see that the valves pumping away. Um And so that's using Hololens on the right. This video never works on the right track today, but it's Proctor Me, which is a uh product from a good friend of mine, which is bringing augmented reality into the into the theater where a surgeon somewhere can be superimposing their finger or an instrument over an image that's going backwards and forwards between the operating site and the remote site. Mixed reality. So I think it's some of the coolest stuff I visit a company in Helsinki, uh dizzy or they take ct images of fractured mandibles, hands, analyze the image, analyze the fracture pattern and then we're the top. I worked out what type of dictation it's best for that fracture. You then put your holy land on in theater and it superimposes the plate on the fracture. And so therefore you then line up your plate, the index that you're seeing in front of you. So you have, you know, you have the strongest fixation possible on the right. This is in Imperial College. So this is a plastic surgery team that for lower limb problema are using Hololens again to show where the perfect disaster, the skin. So you can create local regional flat live knowing they've got a good blood supply because you've seen it on the CT. So as the surgeon moves around the table, all those images stay locked to the leg. They are, they are uh exciting, especially in training. There's great companies like fundamental VR also touch surgery. Um So certainly fundamental. Also, you can walk into a virtual operating room with somebody else and hand tools to one another. Move X ray machines around, take an X ray of your virtual patent and have it predicted up in the walls in front of you. Uh And then people are fundamental will say have haptic feedback. So there's instruments you can use that connected to what you're doing and it's feedback into the instruments as to it feels like you're drilling into bone, for example. And then people like touch who have an amazing library of uh of cases. Uh robots, robots are coming, they're interesting, they are much more in closed cavity. Uh So urology, general surgery applied the big users from a plastics point of view, there's been some use in uh cleft and head neck because you can turn around the 90 degrees of the or different. So really exciting robots just to be clear are currently masters slaves. So you have to have a surgeon somewhere controlling it. We are not at the point so far of autonomous. When people talk about robots, they're talking about this kind of matter slave set up. There is a little bit of this is the trend side of things that someone has gone. We really should do robotics in flat breeding in plastic surgery and it is a tier flat for those that don't know. Um use a breath recon. It takes about 4 to 5 hours to do the flat such finished. They have used it. It is a robot in the States to 18 hours and you to end up trying to cut the flap out anyway. So you get the same start. So you got to think is there a purpose for that? Three D three D printing. The one on my, on the one on the left is my favorite part of the Toll presentation. Um Let's charge with a three D printed prosthesis that had Iron Man come and deliver his prosthesis. How cool is that? Um And we're moving on that, not only is it kind of three D printing, but bio three D printing the ability to create biological frameworks that themselves are printed into. Um So there will come a time when you can have your liver on the shelf that you then that's been printed and you, you then go and plummet in big data. So historically or not really historically because none of this is particularly old but big data was driving had lots of potential for diagnostics and preventative medicine, precision medicine and so on. But it was all very research based and and you, you had to kind of get hold of these huge datasets. This is interesting is that that how many people in the audience have got a smartwatch or a smart ring or a mobile phone in their pocket, constantly collecting data. So suddenly had these big data algorithms are being fed live data all the time. And not only that, but that live data is being sent at rapid speeds to the uh to to the edge or cloud based computers. So you're getting a major insight and this is only the beginning. Um you can now get BP off of the center, the size of watch. So it's suddenly limb surgery. You don't need a big BP cuff. You could just put a small center and get exactly the same responses. Why have hourly Ehlert knobs when, in fact, you can just put a center on and it's done continually and then uses big data to identify trends before it would otherwise even be spotted. And then, um, taking that data, you have amazing companies that are innovating every step of the way. Um So my uh they're, they're doing the kind of lots around um the preh ab obviously the phenomenal Concentric looking at risks and informed consent using that big data and my recovery, using the kind of POSTOP rehab uh data uh on those specialist interventions. As I mentioned earlier, there's lots of time can drug, but it's not all tech, there's an amazing kind of biotech hunting melanoma, which is one of my big interest completely revolutionized by the innovations going on. And the really important thing is that as surgeons, we are at the middle of this where as it used to be that it was innovations were pushed onto us. We're now able to be involved every step of the way to identify the problems and identify the best ways of addressing notes. And these are all companies started as well as other ones we've mentioned already started by surgical uh or surgeon CMR Mrs Slack as a gynecologist in, in uh in uh Cambridge digital surgery gene and Andre approximate Nadine my recovery, excellent tom content trick to be there as well with Daphne head. So they're amazing at clinician led startups. Really changing the land. How do you do last week's slide promised? Thank you. So, number one A B C D, I love A B C D. Um If there are medicines in the audience A B C D no longer means airway, breathing, circulation, disability, it now means always be connecting thoughts. If you come up with a problem in your when, when uh in the hustle, think about how is this done elsewhere. So for example, um passage of patient's from clinic into theater can be cumbersome. Well, where else do we get people from? I've got an initial point of information all the way to a set place at a set time and then get them through it safely. While I would argue that airlines that if I'm booking a holiday, I get loaded information about stuff that's out there. Be a then get my my booking and I then use the be a app for the entire protest and start to finish it and be a make sure I get to the right gate on time with all the right documentation I need. So we need to use some of that, that world outside to work out what we can do. The other thing that for A B C D, it also means connect dots with people. So if there is something you are interested and you need more details on a RVR whatever it is, go and talk to people a bit like Daph said, go and get that coffee. Don't connect the people. Linkedin. They love it. Break Tylo's don't reinvent will. One of the things that is important is that in healthcare we all face the same problems that's global, not just in the UK. So go and talk to how are the orthopedic surgeons down the corridor? How are they dealing with getting patient's interfere, dealing with PRE COVID doing with letters, whatever it is because maybe they have a solution. Maybe they don't. In which case, your problem is bigger than you realize or your potential is bigger than you realize. Don't be to get to fail in medicine. We're not very good at this and obviously the caveat to that is patient safety comes first but try things out. Um And don't be scared to share. Really? Really? And that is my whistlestop tour of health innovation. Amazing. That was uh that was uh I, I loved it and uh much like your, your previous talk, which I think was quite similar, but this was, this was very, very good. I think you touched on a couple of new things. Uh David. Would you like to add anything? Oh, you're on mute. Done it. 2022 problems. And so I think Ryan is kind of a B C D is really interesting and linking to Amanda's question in terms of kind of how do you get involved and you can kind of can you innovate the students. So in many ways, like those who are new to a problem can see it so much easier. So there's that kind of sweet spot of, of for innovation often where you, you come into a problem, you learn a little bit about it and you can see the issues before it kind of becomes ingrained and you kind of just become blind to it. So I think lots of great ideas come from students and, and also so I did a talk the other week and we were doing some um kind of cases to say, okay, here's, here's an imaginary kind of digital solution in healthcare. Like how would you go about it? And what's the kind of go to market strategy? How would you kind of commercialize it or if we're not allowed to commercialize because Ryan doesn't like that? And one of the things that so there was one just example of, of someone I won't get into this. But basically, you know, new generations bring different ideas. So, you know, I was running at this workshop with, with someone else, you know, my age, mid thirties, not particularly old, but still the generation coming through 2021 actually had a completely different approach, like content and like content creation and kind of making money from content. And basically the youtube generation of people who have seen these are like amazing innovators in content and kind of brand in content seeing different solutions to, to, to even what we, you know, 13, 14 years older we're seeing. So one of the questions that was kind of coming for, that was like, they're huge like explosion in innovation and ideas and things coming through with COVID. Like, are we too late as students? And we kind of missed the boat. Like all the innovation happened in 2020 and damn it, we've missed it. It's just, just not true. Like there's just, we're just at the start kind of like Ryan said, we're just at the start like this is the tip of the iceberg in terms of innovation opportunities. There's so many and not only there are so many, but as the next generation coming through, you will just see things differently and see opportunities just because of the way the world has been as you've kind of come through that. And so can you innovate? Yes. Absolutely. Absolutely. You can. And you may well be the best people to do that. Yeah, I, I think that was, that was fantastic. Very good words of encouragement. Uh We have a couple of minutes guys as well until we, until we, we move on. Uh I'll add some questions if you wanna start typing any questions that you guys have. So I think VR and uh mixed reality is going to be essential towards how we're looking at training. Uh There was a conversation I was having in between operative cases where I was talking to a consultant and talking about how their level of training or exposure they got is completely different to what we are getting as trainees now. And we need to bridge that gap. And, you know, I, I have one of these actually unfortunate to have one of these sitting around, but we have, we have nothing, uh, to really use it much for apart from a couple of companies that are allow going, uh, sort of simulation around surgery at the moment. So it would make a lot of sense if we had something like simulation in between either cases or on study days where you can really hone your abilities, uh, and especially, uh things like mechanical or step two step uh situations where you wanna understand what's the next step, what to do in this challenge and be more fluid with your thought process. And, uh, we, we, we do have a degree of that up here in Scotland where we had laparoscopic simulators. And I, I had a theater day today, but I had to get a COVID test because I wasn't feeling very well. And I used, I used the lap simulator for, for my morning. It was amazing. So I, I think it's really good a question that I had for you, Ryan was, uh, uh So there's a thing called the ideal framework that is used around uh innovation in surgery, but more so towards uh things that are more procedural operative. Um Do you think something like this will start becoming a thing in health tech or med tech? Do you think we will have to build some kind of framework in which we can fit in or is there, is there anything in place already? And is this a thought process that people should have when they're moving towards having their own idea or goading uh an idea to execution? Really good question? Um Yeah, absolutely. Absolutely. Ideal framework is a, is used in, in health tech innovation. Um It breaks down the protests from ideas that ideal uh I'm sorry on the spots. I can't quite remember but I idea development, exploration assessment, long term study. But yeah, every today tell there's like a checklist of what you need to do and what you need to present and it's out to your vital because the thing with this a bit, like I said, that we shouldn't be reinventing the will and there is a good chance that actually other people are either being what you've done or drive what you've done and it didn't work for X Y Z. And unless we publish and kind of heart open and transparent about that, and the problem is we will make resources on reinvented, roll over and over again. So I do is fantastic. For that. There are issues with that because not many people want to publish things that are not positive and not many places want to be the publishers, the things that are not. Um So we do, we have a hurdle within our specialties who address that. But yeah, absolutely. Ideal is, is there to try to keep you think, what the core of it is, keep patient safe every step of that way. If you follow the ideal framework, then you'll know you would have ticked off the inch. Now. Can it be improved? Absolutely. Um uh Like all meetings. So that kind of, that's what is in eight and it's so massive and everything feeds into the ideal framework. So there is some flex on that but fundamentally, yes, use ideal or um, and, and we should be published. That's a, yeah, that's amazing. And uh, there, there's been lots of talk about corrections in DC funding and things exploding everywhere. And I think we're very fortunate in a way where in the NHS were very evidence based on what we do around everything. And that sort of mindset is very unique if you go to other industries or take a lateral direction, your career and people, people find that really refreshing. Um So I'll go to a question here in the chat uh, in plastics. Are you currently using or developing a R or M R mixed reality for achieving clear margins in skin cancer surgery? I think that's a good question. That's a great question. Um And as far as I'm aware, I don't think anyone has done it. I think one of the problems is, um uh actually how you would really know because quite often skin cancers, they kind of very underneath the skin. And so the skin looks fine. And so therefore knowing where your margins are difficult and hence that we put these kind of biggest margins. Uh The one I see kind of, I think it's really interesting and it's all my, all my ever growing little things I'd like to do. But after using a are for Rican, so you can and then work out based on the kind of face shape or whatever it is, you can work out what the best reconstruction is a bit like that is your superimposing plates on bones. You can use a are two, well, actually optimum uh recon for this defect is it? And therefore you, you already cut along the lines that you're seeing, you do your colon headset. So as I mentioned, we are, we're just about to trial the rods and cones, headsets. Uh We're also got the credit headset coming. These are two camera based uh setups. And then you've got people like proximity who have been doing remote proctoring of skin cancer lists, uh trauma lists and trauma clicks for a while. So there are pockets but specifically on skin cancer margins. They, yeah, that's uh that's amazing. And you know, it's very impressive. And plastic surgery, you guys seem to be a great cohort for innovation with Nadine, with Proxim. E you've got corny strip with you. Yeah. And then John with touch surgery. Uh, it's amazing. Uh I'm, I, I like orthopedics. I'm hoping some of this actually impacts in orthopedics. So I, I like that you talked about um the, the plates and using ai algorithms to be able to figure out what would be more optimal and uh you know, what can possibly be changed. Um We've got another question here. So let me have a look here one more. Could you expand a bit on funding for med tech here in the UK? So I think I had a chat with you roughly similar to this as well and this is something on most people's mind. Uh Love to hear what you'd like to say today. Um Do you, do you want to lead on this one as you, you're probably going through it more recently than me? Yeah. So um context is gonna us, so we've, but we've taken a few kind of grants and that's how we started off. And then more recently, we've done a kind of seed round with um kind of angel investors and a, a venture capital firm. So I think it's pretty hard to say in kind of one nugget like, what's the approach? So, so first off, there's lots of money out there. So there's, you know, there's, there's a huge amount of money in digital health for the right ideas. You know, if you, if you, if you've got an idea or kind of something that you've proven to a certain extent you'll be able to kind of find money for it. Um, there are other avenues in terms of grants and it's a reasonably grant, heavy space because, you know, there's that kind of shift from research grants into kind of innovation grants and, and again, there's, there's plenty of avenues there. I would, my general answer to that kind of thing is if you have an idea and you're kind of wondering what the right kind of path to take and there's pros and cons, there are different ways and kind of different scenarios, you would go and look for funding at different points. So if you have something that you can really quickly deliver and kind of test really quickly, then then actually might not need some funding straight off. But if it's something, you know, which needs more research and development before you can get beyond, then you probably need kind of funding earlier. So I would just say reach out to people in the, in the kind of industry and hopefully, you know, in a five minute conversation, we can probably give you some reasonably sensible and thoughts on, okay. This might be a good avenue for, for this kind of idea or maybe not, you know, try this. So, and I just reach out to, to, to people in space, including myself, have to have that conversation. That's a, that's amazing guys. And uh like uh like the overall team and Ryan mentioned it already is share NG is amazing in this space. So share your idea with as many people as possible and you'll get the best, uh you know, you'll, you'll get the best feedback. I'm just going to have one more question guys. I'm gonna move on to fill afterwards because I think that's actually really good question. A lot of medics asked, I've asked this many times. Uh So essentially what it's asking is um if you are developing any kind of a app or any innovation that is involves tech, you don't have any development background yourself. Now, David, I think you might be a bit different than that, but generally speaking, um what do you do if you're from a non tech background, you want to execute your idea? Yeah. So it is that ABC indeed that go out to people, it caveats, talking to people is you do need to uh protect your idea. And I'm not about patents and with you on the long term station about that, but at least getting non disclosures, confidentiality agreements in place, they're free, there's lots of great resources for them. Um But go out and talk to people there that they find people on linkedin. In fact, my linkedin conta getting messages from different developers, going anybody, any ideas you need developing. Now, obviously they're looking for business. But there is also organizations like uh co founder, co founder dot com where you can post the kind of basis of your idea to look for people that be interested for free and join you as co founders. You can uh if you want to just outsource, it can go to places like cup work or people per hour. And again, you, you put a rough draft of what it is you want to achieve. And then from all over the world contact you to uh uh two bid for it or final option. Is it some really good courses? It's Code Bed um and Code Blue. So Code Med is a UK group that there are digital skills called Code Blue is a doctor out to Dodge Kate our in. Yeah, who's written a great book and it's how I've taught myself some HTML and CSS to do some uh clinical decision calls. Really 80 quand. And there are, you can teach yourself, you can find a co founder, you can out sort it and there's some great types. I think my, I think my two pennies on that is also do you really need to build anything so you can test out ideas so much further than, than you think you can buy prototyping by marking things up. We see so so many people kind of, you know, spending a few 1000 lbs on, on building something which is, which is not gonna be that great with kind of small amount of money. And you could have just, you could have learned exactly the same amount by doing some really straightforward wire frame mock ups walk things through like in these early stages of an idea, all you need is to kind of show something to someone and get their feel and get the feel of like, is that something, is this something I should take further? So do you need to build? And I think I like Ryan, I mean, so, you know, my day so I'm, you know, I can develop stuff to, to a certain extent but not to kind of build commercial products. So I can write, you know, mhm islands and you know, mobile languages and, and, and stuff to a to a rudimentary level enough that I can take a prototype and kind of make a v naught point, naught one of something which just allows me to play with it a little bit more and then you kind of hand it over to, to people who actually do this, you know, for a living. And so it's always kind of nice to do that because it means you can just get your hand 30 and, and is it some of this stuff like as medics, you're probably gonna, you know, medics who are kind of joining these kind of, you know, innovation, you can kind of talk, you probably will take two to some straightforward html, you know, website building stuff easier than you think. And uh so that's a new age guys. There's no code solutions. There is uh there's all kinds of stuff. There's APD Ivor Elementary or builder dot AI can build an app for you. And uh code Med was uh so you'll see Arent in maybe on Med Twitter and he is the co founder of Code Med. He's a lovely person uh as well and you can see that from some of his tweets. So guys, thank you so much for, for coming today, both Avid and Ryan. Uh I think that was an amazing set of talks. Uh It's, we don't feature MedTech enough. It's starting to happen now. I think it's amazing. We should keep that trend going. Uh We're going to move on to fill. So, thank you guys so much and uh hope to see you again for IBM. See. Thank you. Thanks guys. Take care. All right, guys. So now we're moving on to, uh we're moving on to film a county who's the uh founder of uh Meadow, on which we are all here today and on which we've been doing all of our teaching as well. So, uh thank you for waiting fill were a couple of minutes today and we're going to move on to the Poster Hall straight afterwards. Uh So fill, I'll let you introduce yourself and we'll get going actually here. Um It's um it's really brilliant too to be here. Uh watch uh some of the amazing questions coming through to hear from in credible speakers. I just love uh hearing Daph story. I love Ryan's outlook on innovation. Um And it's kind of great to have his experience at the Royal College of Surgeons of England as well and, and it's just my pleasure to kind of be here and share a little bit about our story um in some ways in innovation as well. Um uh My name is Phil Michael AI am a medic by training. Um uh I was uh cardiac surgery registrar. Um And I then actually jumped into industry for a short period of time and then jumped into med tech. And I'm just gonna share a little bit about our journey, our mission um as as a team medal and then we're gonna jump into kind of poster time before hearing from, from Michael afterwards. Our mission metal is really to make great healthcare training accessible to everyone. And it's borne out of a problem we've seen articulated by the World Health Organization who have explained that we face a workforce crisis in healthcare that we need to train 18 million more healthcare professionals by 2030. That actually means scaling up the amount of healthcare professionals we train overnight by one third. So if we started training tomorrow, uh and we scale that up by one third, then we would meet that 18 million additional healthcare professional target. That's a really tall order, especially when you look at how long it takes to train um some clinicians. So some medics take 15 years to train and it cost $700,000 all in to train um some consultant physicians and surgeons. So it's a really, really tough uh call coupled alongside that is what the lancet have described as severe institutional shortages in our healthcare training capacity. And they've talked about this in their review of healthcare training internationally. It's something that seen in uh low middle and high income countries. It's not a problem that's bespoke to one of those countries in the UK. We need 43,000 additional doctors by 2030 in um India, we need 3.6 million additional healthcare professionals to rule out what's been described as the greatest move towards universal healthcare that the world has ever seen. China required over 100,000 obstetricians alone in order for them to relax their single child policy. And you combine that with institutional shortages and we have this toxic mixture put short, we don't have enough healthcare training capacity to train the healthcare professionals that the world needs. And so we need to start looking at this in a different way. And the World Health Organization has highlighted how this can be done with digital. You begin to cone in on the problem and what's even worse is where resources are at their least. This problem is at its greatest and there are 11 countries on the continent of Africa that do not have a single medical school at all. And for us, we, we can't sit by and let that happen. This is everyone's job to begin to solve some of these problems. And that's one of the greatest things that can happen in innovation is when we stop competing and we start collaborating and that's what we've been really passionate about doing it at Metal. How do we make accessible healthcare training available at scale? How do we not make this all about us? How do we empower the amazing organizations who are already doing in credible healthcare training just to do it more efficiently with more resources to train more people. And that's what we've been working on and we started off solving some really simple problems. When we started listening to healthcare organizations who were delivering teaching and training, we heard patterns happening all over the place. We saw healthcare organizations using about seven or eight different tools as we started to deliver digital education and it was becoming inefficient and people were spending ours setting up teaching sessions when actually they were busy clinicians who needed to focus just on doing the actual teaching. We saw them setting up event rights to take registrations or Google forms if it was free. We saw them posting a schedule on a week's website, we saw them emailing out zoom links and reminders manual. Eight people, people were then joining a Zoom call. After the session, people were being asked to fill in a Google form ubiquitously across the world. Organizations had someone in an office who was copying and pasting names from a Google sheet into word documents and saving them as pdfs and emailing certificates out to people manually. And then after the event, there's only like one gigabyte of storage on Zoom. So people were downloading it and then adding it to Vimeo or youtube and all in. Um don't even, don't even start us on if they were trying to then make that available e synchronously to people after a teaching session. Um adding extra Google form links to their youtube videos or video videos and then the certificate cycle starts all over again for on demand content. And so what we did is we actually just looked at that process and we picked one of those big problems to start with feedback and certification. And we started to build tools that automated that for organizations. And then we started looking at another part of that process registration and we combine those two things. So if you register, you get a feedback form and then a certificate automatically if you attend the event. And then we looked at the video piece, how do people actually join the call instead of bouncing out to another to just bring that into one place as well? And then we looked at catch up content. How do we help them automatically share their catch up content so that they can make this training available. Not just to the people who can attend a quarter to six on a Thursday evening, but people who have low internet connections, whether they live in a row oral area or uh an area that doesn't have a good internet connection, they might not be able to join lives. They might need to go to a specific place towards their healthcare, teaching or training online. Uh So we, we started to make that that on demand piece available automatically. So if they deliver their teaching sessional medal, they don't need to use yet another tool to make their video available afterwards. And we launched it um in February 2021. Um and it was a bit of a bit of a game changer. Um In 11 months, we saw medics in 167 countries begin to learn in the single platform. We saw over 950 organizations joined this mission and say this not only solves a problem for us, it not only makes our healthcare training more streamlined and more efficient, but we actually believe in this mission. We actually believe in making healthcare training more accessible to more people. 950 healthcare organizations running events, hundreds of them every single month and they're making them available to medics in 167 countries. What's really interesting is those organizations are only 20 countries. So organizations in 20 countries are training healthcare professionals in 167 and in the UK, but one third of UK, medical students have actually learned using this product. It shows the power of collaboration, it shows the power of when it's not all about us. And we actually just empower other people to do what they're really good at, We can really make a difference. So I just wanted to share a little bit about our journey. If you're running healthcare, teaching, training courses and conferences, it's really our honor to, to really help you to, to do that more efficiently, to train more people and to make healthcare training more accessible. If you are running an event, it would be our honor to, to provide you with the software to help you to do that. If you're running an open access event, our our heart is that you, you don't run into any additional barriers. And so we provide you with the, the software open access as well. You can just head to metal dot org slash host to set up your event and we would be really honored to work alongside you. Thank you so much for your time this evening. Thanks for joining us. I hope you find this event really helpful. I hope you find our speakers so far, really inspiring and we're gonna hand over to you now. So it's your opportunity to, to share a little bit about your work. We're going to banks to our poster hall. And if you head back to the main event page, you'll see a link on there that says visit the poster hall. We'll put, we'll also post it in the chat for you so that you can just head straight there. We would love each and every one of you to begin to interact on each other's posters, read them, ask each other questions, value other people's work. People put time, blood, sweat and tears into this work and we would love you to ask them some questions and get involved, but it doesn't stop here. So the link will be active on the event after the event is finished as well and you can come back and look at the pool, alcohol at a later time as well. So if you don't get a chance to answer all the questions now, or you don't get a chance to look at all of the posters, now the link will remain open after the event. We've also got prizes at the end of the event for the most engaged with poster. And so, uh so to really encourage you to get involved and to really value each other's work. And then we're going to be coming back here in 15 minutes time at, at 7 30 GMT and we're going to be hearing from Michael Okaka who is a general surgery registrar and the Association for Surgeons in Training, equality and Diversity Officer and the SGB I Monje Academy honorary Secretary. And he's gonna be sharing some of the amazing work they've been doing at a national level. Um That's it from me. She heard anything you want to add before we kind of say, let's all get a booster hall. Um, if so far away, uh, a fantastic, fantastic, uh, great presentation. Uh, if, if there was a presentation to convince you to use this guy's check it out. We've been using metal for months now and uh uh I think I've said this many times thousands of people that we received feedback from and it's changed the way that we carry out teaching. Um So, uh I see you on the, on the poster hall. I'm going to head that way myself. Super. Thanks you here. Thanks everyone. Fun. All right. So, welcome back guys. Uh poster. All looked great. I got a chance to have a look at a couple of posters and uh it's really, really phenomenal, the, the amazing, amazing content and research that we've got to do, check it out and will remain on their, their after. So, you know, if you didn't get a chance to check it out, so we've got uh with us today uh uh for the second part, Michael Costa, who is the asset he in the office. Er, he's a father of three. He is also the creator of 50 faces of surgery which I hope to hear about today. Uh And he's on the A S G B I uh educational committee. Uh, and he's passionate about Q I and med. Uh So I'm going to hand it over to you, Michael. Thank you so much for coming. Hi, thank you for having me. So today I kind of want to talk to you about leading change in surgery. Um I want to give you some tools that I used to whenever I'm planning a project um and trying to, to focus on what I'm trying to achieve. These are the tools that I use. So there's this framework that I think Simon's cynic made famous with why, how, what and on top of that, always add, evaluate why relates to why do you want to make the change? The questions you need to answer yourself is why is this important? Why does it matter? And why should people pay attention? Is there something that's important to me? Is it something that should be important to others? And when I say, why does it matter? Well, there are lots of things are important in the scale of prioritization. Why does the spotlight need to be on the work that you're doing now? How can you get the spotlight is a question that you can ask yourself later. And right now, people's attention is really divided. You've got COVID, you got big political things going on. You've got the day to day stress of life. As we've seen, the economy has been, become more difficult, more turbulent. And you have to say, why should people pay attention to what you are doing? And I think one of the tools that I or one of the lines that has always stuck with me is if you can clearly describe the problem, you were halfway to the answer. And I sat down and I said, why does equality, diversity and inclusivity matter to me? And I wrote this piece for the Royal College of Surgeons training bulletin. And I would ask you all just to read it. But it, it really helps me clear my thoughts as to why it's now the time for people to focus on equality, diversity and inclusivity. We've got major uh major issues of burn out. We've got issues of COVID. People are tired, trainees are begging to be seen as equals and have equal opportunities. And if you go on Twitter, you can see right now about the L G B T Q I A plus community are really struggling and really fighting to get their voice out there. And I think now is the time for us all to start treating each other with care and respect. And that's what my wife is for the work. I do. The next question you need to ask yourself is how now this is always a challenge and this is something I phenomenally bad at. So I always ask other people to join me on my battles. But the questions you need to ask is how will you make an impact to the thing that you are centered around? How can I make a change in the E D I incentives across the country? How should this be carried out? Is a slightly different question? Is this a project? Is it a paper? Is it uh meetings? Is it a forum? Is it a conference? These are all questions I have to ask myself before I set out. So I have it clear in my mind, what exactly I'm aiming to achieve? And the next thing you have to ask is how can I involve others? I will say behind every successful project I've done have been teams of people with our E D I workshop course, which is now a pre course uh pre course at the Asset Conference in March. We are really shapen the neck, the culture of surgery for next decade were making big changes to how we communicate with each other. The language that we use, we're bringing in lots of organizations, disabled doctor's network, the police. Uh NHS people, people who care about the community of surge of surgeons and we're changing the language of changing the behaviors were changing and giving people the ability to call out things. And I think involved in all these organizations has made it such a strong project. The next question is what, what is it. I am trying to produce what is the end goal? What is the end product and what do I have to do personally to get this project over the finish line? When you're defining your end girls with any project, you want them to be achievable, you need to set realistic targets with all my projects. I think what of it? But I am trying to, what is it? But I'm trying to impact a change in and how do I measure that? Is it the number of views that we get with 50 faces of surgery? Is that the conversations that started on Twitter? Is it with the workshop? How many people say that they've benefited from it and the real life impact that has you've got to define what your end product is. I think there should always with any work that you do, there should always be a visual aspect, there should be a statistical data or evidence based aspect and there should be a communications aspect. And with these three things, you've got a trifecta of getting messages across the people and it always works. And personally, I always like asking myself this question, what do I have to do to get this over the finish line again? If you can clearly right up the things that are required, you will have half the problem solved. For example, when I first started 50 faces of surgery, there were lots of components to it. We had to work with other organizations to find the time. We had to get people to put in uh suggestions of who to interview. We had to bet that we had to work out when we're going to record how we're going to record. At first, I really want to do it face to face, but then the pandemic hit. So then we had to work out. Can we do it resume? Is it still as engaging? Then we have to work out how we're gonna edit it? Who's gonna edit it? And we, I sat down and I wrote this all out and I communicated with my team members and I said, look, these are the things that we need to do to get this over the finish line to get the first episode out there in time and it works. And I'm pleased to say that one of the big projects that we're working with in terms of collaborating people and putting something out there is we're working the Royal College of Surgeons first time. It's been announced on the 24th of September. We're going to have an inclusivity and well being do. Uh And this is a day about bringing people together so we can hear about your why, how, what we can hear about your projects that you've done, we can take those projects and help them become national initiatives. And I'm really looking forward to this day and there'll be lots more information coming your way soon in terms of defining your evaluation. Uh I said set realistic targets for R E D I workshop. We set out that we wanted people to have strategies to tackle discrimination in the workplace. In this workshop, we talk about things like ally ship, what is bias, what is sexual harassment? What is billion? And when you have clear definitions, you're able to sort things out in your mind when you see something happen and you, you have a framework to work within. And with this, we were able to put this workshop out there. We've run it a few times now. And 96% of participants you go on the course, come away with a strategy of knowing what to do when they see discrimination in the workplace. And for me, that was one of our key measurable outcomes. And when you build up a lot of momentum and you're constantly evaluating and learning what you can do differently. You get amazing opportunities and people get involved and I'd like to share with you a sneak peek. Our next episode of 50 phases of surgery, which will be out tomorrow at nine AM. I just realized you can't hear the sound. So I'm gonna re share it with the sound. Uh The sound was the sound was playing there, Michael, I think. Oh, my bad. Okay. I'll do it again, sir. No problem. Knock, knock. Hi, I'm the new med student. Hi. My name is Michael. Walls. I'm 1/4 year medical student at Cornell University in California USA. I'm also the Presidente elect of the American Medical Student Association. Hello. My name is Vishal Shar. I'm the National Medical Directors Clinical Fellow to the Royal College of Ophthalmologists. I'm also representative on the ophthalmologist and Training group and I'm especially registrar in ophthalmology based in London. Hello. My name is Lily. I'm a medical student at the University of Bristol. Currently inter collating. I'm also on the committee for the Bristol Women in Surgery Society and I'm assets, equality and diversity ambassador group lead. Hi, I'm Michael Akasha. I'm a general surgery registrar in the Southwest and I'm the Association of Surgeons in training equality and diversity officer. I really hope you enjoy this episode of 50 Basis of Surgery. I hope that it leaves you feeling valued, inspired and most importantly, welcome here I am. You are good. Yes, I do. Yes. Ah, there is no doubt that almost every doctor surgeon, a medical student worldwide has watched Dr Flannery also knows his doctor Glaude Complexion. Dr Flannery is an ophthalmologist, comedian, writer and viral tiktok star based in Oregon USA where he lives with his wife and two Children. Originally from Texas. Dr Flannery completed his undergraduate studies at Texas Tech University Medical School at Dartmouth College and registered insee at the University of Iowa mixing medical education with comedy. He now has over 1.2 million followers on tiktok and 46 million views. He has served as editors in chief of Iran's and has published in both the ophthalmologist and British medical journal. And in 2020 was named one of Portland's top doctors by Portland Monthly magazine alongside his comedy in ophthalmology. Dr Flannery has raised tens of thousands of dollars for first Descents, a charity that provides free outdoor adventures for young adults impacted by a cancer and other serious health conditions. Welcome. And thank you so much for joining us. Thank you so much for having me. I'm excited to be here. So the first question is, can you take us through your morning routine? Well, um first of all, fortunately, I'm an ophthalmologist and so I don't have to get Michael the video. Just stop for a second. It's okay. Uh It'll probably play back up if it is ready to. That's as much as I can share at the moment. I see the rest tomorrow. I see. I see. So that was part of the presentation. Mm So the final bit is evaluating your work. Um So I think when you evaluate your work, you need to do this in three stages. The first is we're really, really bad as medics as healthcare workers were really, really bad at setting our own internal motivators in our own internal benchmarks. We often rely on the, you know, the throughout med school you're told that you have to pass exams, you have to jump through Lasoski, you're assessed by external in vigia laters the whole time you get into F one, you have an A R C P, you're assessed by external vigia laters the whole time. And it's really difficult to set internal motivators or assess your internal uh parameters. And I think with all the work that I do, I always have to work out. What is it that I personally want to get out of this work? What is it that tells me that I have made this work successful? Um And, and the way I do that is I have a honest conversation with myself. And I say, look, you know, I'm one person, there's only so much I can do what will make me happy. What would make me think that my work has got out there? The next thing is the external assessment asking people's opinion. What do you think of this project? What do you think of this work? And from that, from those two things, you get an idea of what do I need to do next? Um And always ask that question and I always find that question is really powerful because it starts you thinking, what can I do to improve? Does it need to be improved? Yeah. Who else can I involve? How else do I get to work out there when you can start asking yourself these questions? That's when you can generate real impact for work. All right. Open to questions from the floor Okay. So fantastic. So guys, if you have any questions, uh Michael, that would be a great time to put them through, but I'll let them type the questions Michael, but I'll ask a question first myself when you were making that video and you were trying to find a, I guess we, we have people around us that come from all sorts of different backgrounds. What kind of challenges did you find in making sure you had sort of representation for as many people as possible? And did you, did you sort of have a plan or, or, or a strategy for that? And is this something that we can learn in terms of any projects that we have to make sure that we, we are as inclusive as possible? So I think trying to be inclusive as possible has always been a goal of mine and you know, I found it really, really eye opening when you, when I put the question out to the public. So at the end of our last Asset conference, which was hosted on Medal, we asked, can you give us nominations for people that you think have an interesting story back to share their experiences? And we had about 70 nominations within a week and we sat down and we got in contact with some of these, some of the nominations and we tried to filter out who is it that wants to share a story? Look at the balance sheet. Have we got stories that represent the LGBT community. Do we have stories that represent black surgeons, Asian surgeons, women surgeons, male surgeons, white male surgeons who've come from difficult backgrounds? Have we got these in the picture? And when we started piecing this all together, I felt that we really, really mentioned a lot on ahead and I have to thank my team, especially Ellie priest when and really for helping me get through these. Yeah, I think, I, I think that's uh fantastic and, and fill actually asked a question as well as uh have you seen any challenges in rolling out this really important initiative at Acid? Uh And how did you overcome them? So if you could briefly give us a sort of an idea, I'm sure this could, you could probably talk uh long time about uh what, what, what, what do you, what do you, what do you think you, you did to overcome any challenges you faced? So I think the biggest challenge whenever you're starting a new piece of work is having the vision to see where it's going and what it needs to be like when I first put out 50 faces a couple of years ago, everyone thought it was a really great idea, but it was in terms of how do we get people to actually sit down and talk openly about a challenge that they face in a very close community that is surgery? Um And we found that once we recorded the very first episode with prof batty, people wanted to be involved. And that was the, that was the thing to help us get over the line. Uh And we could share that episode and everyone's like, oh my God, this is really important work. I'd love to be part of it. Um So that was, that was the first hurdle with things like the workshop. I think it's knowing uh knowing the depth of work that is required. So I started off being like, I want to do a course where everyone can learn about E D I. And then it says, what does that course need to entail? And suddenly you have, you know, people throwing out ideas that you didn't even think of, you know, wilding participation. Why have you not included that in your original plan? Why have you not asked the police for advice on sexual harassment, these kind of things? And actually, when people come together and give you ideas, it's really, really great. Yeah, I think, I think that's fantastic and it really helps to have someone to uh sort of bring, bring whatever project you have forward. Uh and you know, give you their endorsement. I think there's some common things that, you know, perception makes the biggest difference. Uh And if you're a woman in surgery, if you're from an ethnicity that's not well represented the surgery, whatever it may be, we feel these subtle things uh as an international medical graduates. But what uh and being of course surgical training. And before that, I was told I'm going to have to work twice as hard as someone else. We're going to have to do this a certain way. And, and the thing is these things are probably uh factored in many times more for people that may have experienced this before us. And you know, at perhaps at the end of their journey now, but it helps us to understand the perspective that much more because representation really helps us provide better care in the end for our patient's from all kinds of backgrounds. So I love that. Thank you so much and uh you can see it, you can become uh uh is there just before we go, is there somewhere that we can catch up with uh with, with any updates that you guys may have? Or is there, is there something that we can link for 50 faces of surgery if you follow the asset official Twitter feed and I will get Phil or send fill the link to all the 50 faces episodes that we've got out. So you people can, some people can watch and I'll also send a link to the pre conference workshop, which I'm really excited for. Fantastic. So guys, any questions coming, keep them going? Thank you so much Michel, really appreciated that. And we'll try and address anything at the end if we can, uh we are now going to move on to, uh, Miss Elizabeth Chip who is a consultant in burns and plastic surgery and she's the training program director in the West Midlands scenery. Uh, she is on plastic surgery training committee. Uh, so, um, she's a plastic surgeon in Birmingham. She's specializing in burn surgery in both adults and Children. Uh, so I'm gonna, I'm gonna, I'm gonna leave it here. I'm going to, uh, hand it over to Miss Chip. Uh Thank her for being here today. We'd love to hear from you. And if there's anything I missed, please, please do add. Thank you very much. Indeed. High. Thank you so much for the invitation to come and speak to this evening. It's, it's great to see so many people online at this time on a on an evening. So you're obviously all really keen and it sounds like you've had some great speakers ahead of me. So I'll hopefully follow that up with something very slightly different. Uh, bear with me while I share my screen. Okay. So I've been asked to come and talk to you this evening about women in the surgery and uh my backgrounds here I work here. So the picture on the top left is the Queen Elizabeth Hospital in Birmingham. On the bottom left is Birmingham Children's Hospital. That's not me in the middle. That's just a generic female surgeon looking like she's about to do something important. So, so why do we need to talk about women in surgery. I must admit when this topic comes up, I always feel a bit of a fraud because personally, I don't feel that women in surgery any, any different to anybody else in surgery. So why do we need to talk about this? So I started to a bit of a bit of research, bit of homework and this data is from the Royal College of Surgeons of England, looking at the number of consultant female surgeons as a proportion of the whole workforce. So you can see that back in 1991 just 3% of consultant surgeons were female. And this is increased significantly by 2020 but it's still only 13%. So there's definitely progress there but probably still quite a long way to go. So this data is from women in surgery. Uh And again, that begs the question, why do we need an organization called Women in Surgery? There isn't an organization called men in surgery? So why do we need it? Is it really necessary? So I thought I'd go back and look a bit of history. So this picture here is somebody who was known as James Barry, but actually born as Margaret Bulkeley. Uh She was a lady who was born in Ireland to a large family and she actually studied at Edinburgh Medical School back in the early 18 hundreds, but always disguised herself and passed herself off as a, as a male. She managed to pass the exam of the Royal College of Surgeons and then served for many years as a very successful army surgeon, performing many procedures, including the first Cesarean section, which was known to be the first successful one in that mother and baby both survived. It was only after she died of dysentery in 18 65 that she was actually discovered to be a woman, a child lady laid out her body and noticed that she got stretch marks, uh publicized the fact that she was a woman. And Furthermore had probably had a baby at some point. So, you know, quite a shocking revelation that she had practiced as a man all this time, but was actually probably the first practicing female surgeon. So since then, there's been an increasing number of famous female doctors, Elizabeth Blackwell was the first woman to to gain an MD in the States back in 18 49. And in 18 70 for the London School of Medicine for women was formed. So there was a need for a whole school of medicine just for women. Um But interestingly, the board of examiners at the Royal College actually resigns in 18 76 in preference to letting three women sit the diploma in midwifery. So there's still a lot of reluctance to let women into the profession, the first woman to receive the F R C S Fellowship of the Royal College of Surgeons of England. Back in 1911 there were just four fellows by 1919 and you can see that the numbers have increased over time. So, are we heading in the right direction? We've gone from 3% to 13% but it's taken 30 years to do that and we're still only at 13%. So, what's going on and why are we not getting equality with our male colleagues? So, I'm a plastic surgeon, uh specializes in burns, but I do all sorts of plastic surgery. And I thought to have a look at the data according to specialty. So look at plastic surgeons and actually we beat that 13% is about 21% of plastic surgery consultants are women. You know, we're doing pretty well. You can see the pediatrics are quite a female friendly specialty. Some of the others such as trauma orthopedics and neurosurgery have even lower than average number of female consultants, but plastic surgery is a bit above average. So I thought, yeah, we seem to be doing quite well. They're quite a leading specialty. But actually when we look further, 64% of medical school entrance or female by time, you look at plastic surgery, registrars, higher surgical trainees, that's just 44%. And plastic surgery consultants are just 21%. So what is causing that sort of attrition of females from the point where they enter medical school to the time when they become consultants? So um as it was mentioned, the beginning. I'm the program director, training prone director for plastic surgery in the West Midlands. And as part of that role, I have an annual appraisal with the head of school of surgery. So last March, I sat down with my uh for my appraisal and we talked about all sorts of things affecting our trainees in the West Midlands. What's happening with A rcps with the annual appraisal process, recruitment things that are going on in the various training units. And of course, no appraisal at this time would be complete without talking about the effects of COVID. So we talked about all of these things that's all fairly standard and nothing out of the blue there. And then all of a sudden the head of school of surgery said to me, so what proportion of your trainees, a female? Uh and I looked at it like this, I was genuinely flabbergasted really? I don't know. Actually, I have no idea as a female consultant myself, I have no idea what proportion my train is a female. But actually, why do we need to know? Is it really important? So I thought I'd better go away and find out. So in the West Midlands, in our regional training scheme, we've got 25 trainees and 11 of them are female. So 44%. So we're bang on that national average for plastic surgery trainees um to and and coming up to three trainees when one returns from maternity leave work less than full time ranging from between 60 and 80% of the whole time equivalent. I want to look at our training committee. So I was a little bit of a cheat because I take both roles of both the chair of the program chair of the training committee and the program director. So there is a female chair and TPD. But actually looking at the rest of our 10 committee members, only two of them are women. So we're not doing very well here where I work at University Hospital blooming, um is probably the largest plastic surgery department in the country. We've got a total of 42 consultants between burns, plastic surgery and hand surgery. So certainly one of the largest, if not the largest departments in the country. And when I look down our list of consultants again, it wasn't something I thought about before. I was surprised and shocked really to see that only 12%. So only five of our consultants were female. Um including myself, all of them work full time. Um And our staff includes Ruth Waters, the lady on the right of your screen here. Who's the current presidente of Operas, the British Association of plastic reconstructive and aesthetic surgeons. So we've got really the leading plastic surgeon is a female surgeon in our department. But despite that, we've only got a very small number, very small proportion of women. So what's my experience? And I have to say that I've never that I know of experienced any difficulty as a female surgeon. Um I've had a pretty straightforward career so far. Maybe that's look, um I like to think it's because there is genuinely no difference between male and female surgeons, but maybe I'm being naive. So I went to Birmingham Medical School back in the last century, rather depressing Lee. Um I completed a foundation year and then moved into basic surgical training just before the foundation program became fully established. And I did various jobs in the West Midlands and in Yorkshire. Uh and then up in the northeast before getting my training number back here in the West Midlands. Uh I trained between 2008 and 2014, including some fellowships. And then I was lucky enough to be appointed as a substantive consultant in burns and plastic surgery here in Birmingham. In 2014, I discovered just several weeks actually after taking up that consultant post that I was pregnant with our first daughter who came along in 2015 and our second daughter two years later in 2017. Uh I've always had a strong interest in teaching and training and I took up the role of training program director in 2018. And I've worked full time throughout my career. Apologies. What's my slide. But people often ask, you know, what, what's your, what is your day? What is your week look like? And certainly when I was a medical student and, and even a surgical trainee, I thought that being a consultant surgeon was all about operating. Uh and I got quite a shock when I took up my consultant post and realized that actually, that's not the case. So this is my, my sort of typical weekly timetable if I'm not on call for that week, and I work 12 sessions. So 10 sessions is considered to be full time and I work 12 sessions. But despite that, because of the sort of vagaries of the job plan, I managed to have Mondays is my non N H cast A. So Mondays my day for childcare or a bit of time to myself, taking up all the things that I enjoy doing out of work. Tuesdays are mainly uh admin and, and other activities, what they call S P A supporting professional activities. So all the things that go into making you a consultant. Wednesdays, I either work at the children's hospital or I do a peripheral clinic in a local hospital and do some skin cancer. And Thursday is my only real full operating day where I operate mainly on patient with acute burns, burns, reconstruction and general plastic surgery. Friday is then multidisciplinary team meetings, uh perhaps a pediatric list and then a clinic. And we currently do a one, it's actually one in 5.5 on call rota at the moment covering both pediatric and adult burns surgery. So sometimes my week is a lot busier if I'm on call. But generally that's how my week looks and only one day of that is operating. So, what else do I do? So, all these sorts of things on here, really? My week is busy and varied and no, two days of the same which I love. So, you know, most days will include a ward round. We have a very strong multidisciplinary working ethic in burns. We I'm involved in teaching and training in research in clinics. And I also have some other roles within the trust which I really enjoy aside from my clinical work. So I'm currently the chair of our Hospital Clinical Ethics Group, which is a fascinating role. Uh And I've also got an interest in intensive care, which I was lucky enough to develop, uh lucky enough perhaps to develop during COVID when I was redeployed to uh I T U for a period of several months. So what about life outside of work? People often think that surgeons, you know, work very hard and indeed they do the hours can be long. Um And the job is, is not necessarily a job that finishes at five o'clock. Um But what about life outside of work? I think it is important to keep a work life balance. So this is a picture of one of my favorite places looking between the ears of a horse cross and rolling countryside. And that's one of the things I really love to do, particularly when the weather's as good as that. I'm quite a keen runner and this is me finishing Birmingham half marathon with a close friend of mine. And the other thing that keeps me very busy at the moment is my two Children have literally just managed to get into bed before this talk, which is why it's at least relatively quiet in the background. It's my two young daughters who are in absolute pleasure most of the time. So a question that's often asked is how do we support female trainees? Uh And again, I would throw that back and say, well, actually, how do we support trainees? Because if we support all trainees, then we're supporting female trainees. And I don't think that generally female trainees require any additional or extra support, but we should be supporting all of our trainees. So actually, there are lots of ways within the trust that you work, you'll find a whole range of people to help and support. You have clinical supervisors, educational supervisors. And if you're a surgeon in training, a college tutor who is employed by the trust as well as the college, a couple of relatively new roles are the guardian of safe working and the freedom to speak up guardian. And these are people employed within the trust. Recognizing that there may be issues, conflict problems, uh difficult situations that people feel it's difficult to escalate or they don't feel confident to escalate. And so these people are really here to take those things forward on your behalf. So the guardian of safe working is mainly relate to rotor patterns. Um making sure that people are working safe hours, they're not exceeding their European working time directive, for example. And that's the person to go to if you're having difficulties with uh scheduled shifts and rotor patterns and the freedom to speak up, Guardian is actually much wider role. So anything that anybody is concerned about, you don't have to be a medic. This is for all members of staff, any concerns that they have about patient care about working relationships, all sorts of things, the freedom to speak up, Guardian will be there to take those issues forward on your behalf. And then outside of the trust, there are also several routes to get help and be supported. So, in the West Midlands, we have two trainee reps, relatively senior registrars who've been elected by their peers to again take forward any issues concerns. They basically act as the two way conversation between myself, as the training program director and all of the trainees, the TPD themselves might be somebody that you can approach if it's an issue that you feel needs to go higher than that the head of school of surgery. And we're incredibly lucky in this region to have a really excellent professional support and well being unit, which I'll talk a little bit more about in a moment, you're probably all aware of the Bawa Garba case a few years ago. And there's a direct result of that very tragic case was formed, a system called support, so supported return to training, which is especially a scheme, a national scheme run by health education England, which comes with a huge amount of financial backing to help people returning to work, whether they've been off on perhaps parental leave for a period of sick leave or they've been out doing research, for example. So that's really aiming to avoid those situations where somebody returns back to training and it's sort of thrown back into a busy rotor without any chance to acclimatize. And we do have representatives who will help support particular groups of trainees. So for example, trainees working less than full time and that's no longer a position that's necessarily exclusively occupied by female trainees. There is a big drive to making less than full time working more accessible to anybody for, for any reason, whether that's for caring responsibilities, healthcare reasons or just for trainees who want to establish a better work life balance. So a professional sport and well being, you know, as I say is a real gem in the crown of the West Midlands with nationally renowned to be probably one of the best units in the country. And this is set up that trainees can refer themselves or by their trainers and it's for any trainee really who's struggling with anything inside or outside of training things in their personal life or their work life. And it's a confidential process and that's very closely aligned to this supported return to training scheme that we've already mentioned. So there are lots and lots of ways of supporting our trainees. And within that, that includes our female trainees, a document called enhancing junior doctors working lives was produced, recognizing the fact that junior doctors working lives can certainly be improved, uh say less than full time working is much more common now. And there are various things that we do to try to make our trainees lives a bit easier. So, you know, we try and give them as much notice as possible about where they're rotating to next, give them advance notice that their rotor and things like that so that people can plan, they can decide where they're going to live. Are they going to move house? Do they need to rent somewhere? Do they need to arrange childcare, for example? And all these things are much easier to do when you've got plenty of notice. Of course. And then more recently in August of last year, a new surgical curriculum was established, moving much more towards a competency based rather than time based training program. So no longer, do you have to serve necessarily a certain number of years? It might be that you're able to get to the end of training more quickly or indeed, that you might need a little bit longer to reach those competencies. And so that's a recognition really that all trainees are different. Everybody takes their own time and some people will, will get there quicker or slower than other people. And that's absolutely fine. So I think all of these measures are really important to support our trainees. So in conclusion, really, how, how do we support our female trainees? How do we support our trainees in general? I think by supporting everybody, we will support those, those minority groups who perhaps are less well represented. And with time, I think, I hope that the need for things like women in surgery and talks about things like this and, and how women managing surgery will become less necessary. I hope that as TPD and that all the members of my training committee are approachable, supportive and sympathetic. Um This is another gratuitous picture of my two daughters. Here's one of my favorite pictures of them and just to remember really that yes many trainees will have um perhaps Children and family. But also there are many other reasons why people need to have that work life balance. So they may have caring responsibilities for family members. We've got a training, for example, who play a semi professional rugby and people have various hobbies and interests and things outside of work. So that tends to be associated with female trainees. But actually many of our trainees have other pressures aside from work. And it's really important that we support all of them uh to make them the best surgeons that they can be as well as the best person outside of work. I'd be delighted to take any questions and this is my email address. If there's any questions people have at a later date that I'm not able to answer or something you think of later, do feel free to drop me an email, get in touch and I'll do my very best to help. And thank you once again for the opportunity to talk. Thank you so much. Uh Mr That was amazing. And uh I think the very pragmatic idea behind that if we all treat trainees the same way, it doesn't really matter whether they're male or female, we just have to have an element of support and that's really all that matters because male trainees may need that support the same way female trainees do. And uh I, I like it. You guys have a great culture around that and uh I think it's something that we need at this stage after the pandemic. Um I think Michael had a question that you wanted to ask. So Michael, I'll invite you back onto the stage. Uh If you've got a question there, thank you for that. That was really, really nice to see what a supportive Dina re looks like. What would, what would you say to the trainees who probably or who come up against TPD S who aren't so open, who aren't so supportive? How, what would you say to those trainees? What, what would you tell them to do? And so I like to think is it maybe, maybe I'm a bit naive. I like to think that, that everybody in training is in training because they're very passionate about training, which is essentially to help guide trainees through the, through the training pathway to make them the best doctors that they can be. Um, you know, it would be disappointing to think that there are people out there who, who don't have that objective. But I think it's important for our trainees to know basically the different people who are available. So, you know, if for example, you have a training program director that you don't feel you can approach for whatever reason, perhaps they're not supportive or, you know, they haven't been terribly helpful or you just feel, you know, you haven't particularly got a great relationship with them. Some people just jelled and then some people don't that it's really important for trainees to know that there are other people to go to. So there will always be, every trainee will always have their educational supervisor, they'll also have clinical supervisors there work in a department undoubtedly with many consultants and almost any consult I think will, will recognize that they've got some sort of element of pastoral care in their job. Other trainees, there'll be trainee reps, there'll be college tutors, they'll be the freedom to speak up. Guardian, so on and so forth. So I think it's important to know that there are other ways around and, you know, actually TPS our, you know, our human, we've all been there, we've all been through training. We should recognize the difficulties. But if you're really finding that, that somebody you can't approach or you've approached and you're not getting the answer you want, then there are lots of other avenues open to you, obviously, depending what, what the issue is. Um, but I think, you know, I do feel very strongly that actually, uh, it genuinely surprised me when my head of school said or how many of the trainees, female? Well, I don't know because I don't see them as male or female, like, you know, I, I personally really don't think it's an issue. Maybe I've just been very lucky that I don't feel I've faced any problems as a female surgeon. I think surgery is difficult. You know, nobody will ever tell you. It's not, you know, it's a tough career. It's tough whether you're male, female, black, white, straight, gay, you know, whatever, it's a tough career. It should be, you know, your, your sort of holding people's lives in your hands at the end of the day. It should be tough. It should be difficult, but we should support people to manage those difficulties. Um, get there and be the best surgeon. They can be. And I, you know, I feel really strongly about that. Yeah. So thank you for that question, Michel. Uh I have uh I have probably one slightly longest question as well, but it's quite interesting. I think the fact that you had an experience where uh you sort of looked at it, looked at what your objectives and goals were and went through it and, you know, uh didn't have to face some of the other things that people face. There's a question that someone's asked her about um practical life situations that we have. So what was your experience with having two Children and pursuing surgical training? Did that possibly uh seem like a challenge? And the person asking is quite keen on surgery as well? And did you ever feel the need uh to go less than full time, which is something that's becoming slightly more understood and more common? Now, um I think that is essentially it. Uh and they also touch on that they're scared about being able to cope with family medical projects, hobbies on the sides and the fact that it's really challenging being in full time training. So I'd love to hear your, your view on that. Sure. So thank you for the question. And I think my situation is slightly different and that I had my Children when I was a consultant. Um So my experience is a little bit different. I would start by saying, I think having Children it's probably the hardest thing I've ever done. You know, surgical training is walk in the park. I'm being slightly flipping, you know, having Children is difficult, having surgical career is difficult and, you know, I think there's no doubt that combining the two is difficult but it's perfectly doable. And I, I suppose I've been lucky to have lots of good role models when I went through my training. So, so the picture I showed you earlier of Ruth Waters, who's the current president of operas. Um She has a family, I believe she had, she started her family when she was still training. All of the sort of female role models that I've worked with have all always had Children, had a family. So to me, it has been a sort of normal thing that you can do. Um, what I would say is that life is a consultant is much easier than a trainee. So, you know, my working week that I put up there is much more flexible than, than life as a trainee, you have much more control over your job plan over what you do. And so, you know, absolutely the case. I think that having Children as a consultant is probably more straightforward than, than as a trainee. But equally, I know lots of trainees who, who combine that very successfully. As I say, we've got several trainees in our region who've got Children. Some of them were at full time. Some of the work less than full time and, and I think to sort of answer the question in parts. Um So I'm very lucky we've got a great setup. I think you're reliant on really good childcare. If you're going to continue to work and you have Children, you know, you're reliant on, on good childcare. We're very lucky that we've got a fantastic nursery within the grounds of our hospital, good opening hours, really flexible and, and touch wood have Children who sort of fairly robust and don't seem to come down with any coughs and colds. Um My husband is a consultant surgeon as well initially in a different hospital now in the same hospital. So that helps because we've got a bit of flexibility. Um We don't have family nearby, uh you know, which makes things a bit more tricky, but we've got an absolutely amazing child minder. And now my Children have just started school that both at primary school and we're absolutely reliant on a phenomenal child minder. Really good wraparound. Yeah. And you know, we, we pay a lot of money for the privilege other people might use family. Um You know, maybe their partner has different working hours that can accommodate that. So you, you've definitely gotta have a plan and I think good childcare is essential and you've just got to accept that sometimes your child will have a temperature that will be and well, you have to leave work to pick them up early or we have to stay at home. You know, and I think people are generally pretty accepting of that. Um, less than full time training. Yes. It's not something that I ever considered. I think it probably would have been something I would have considered more if I had started my family as a trainee, as I say, I think as a consultant, you actually get a lot of flexibility. And so it's not something I've ever felt necessary to do, but it's something I would consider if my circumstances changed. And it is definitely becoming increasingly common. So we've got three out of our 25 trainees are less than full time. And um you know, it's just very accepted now, I think, uh you know, it's definitely move away from your only less than full time because you're a woman and you've got Children. You know, there are a multitude of reasons why you want to wait, might want to work less than full time. And it can be, as I say, you know, we've got people doing high level sports, having different hobbies, maybe you care for family members, maybe you just recognize that actually working full time is not what you want to do. And you know, there's an increasing recognition that that's fine. I think there's a big move towards realizing that people need to have a work life balance. There is life outside of work. Yes, you're training to be a surgeon but that's not the only thing in your life. And so I think less than full time works really well for a lot of people. Um, but I think, you know, if, if you take out nothing from this is that it is possible to do all these things. I mean, I think we all have times when you, you're juggling but, you know, having Children is one of those things to juggle. But it is possible it's difficult but it's doable. I wouldn't change anything about my, my job or my family and say some of that is definitely luck and kind of circumstance and, you know, happening to find a good child minder, it definitely is quite an expensive thing to do with childcare. You need to be pretty organized and, yeah, you know, ask me again at 6 30 tomorrow morning when I'm trying to get the kids out of house and I'm screeching out and put the shoes on. But, you know, it is, it is doable. And I would say to anyone if, if you want to do surgery, you have to want to do it for the right reasons and it will be tough. But, you know, don't ever think you can't do it. Um, as, as Michael said, if you want to do something, you can do it and if you want to do that with Children or a hobby or another career on the side, you know. Absolutely. You can do it um, if you want to do it, you will get there. Yeah. No, I, I think that's, uh, that's, thank you so much. That's practice answer. And, uh, I think one thing you might possibly be lucky on is the fact that you have a fantastic facility for child caring, uh, in the hospital. I think that'd be amazing. Maybe something to think about for, for, for other places. But I think support is such an important thing to have around trainees because I think you might be very right and being a trainee in myself and Michael might agree with this. There's loads of pressures and currently with things like elective lists being canceled, you constantly worrying about your numbers. We've just coming up to our six month mark and I'm counting my case is how many have I done? What's sts, uh, that kind of stuff? It's, it's really, really stressful and you're juggling everything else with it. Um, so I think that burnout is going to be a thing that people, people will inevitably experience, but to touch on less than full time surgery, something very interesting that someone mentioned to me a few days ago is that we're moving towards a competency based system and people might actually, uh, you know, benefit from that where, whether you're full time, less than full time, what you're doing is going to be assessed based on your competencies. And, uh, it would be interesting to see how that progresses uh into the future. Uh, but thank you, thank you so much, uh, for, for a rather insightful, uh talk and we, we hope to have you and, uh, Michael back again and, uh, we hope everyone enjoyed the talk for tonight. If you have any last questions, guys, before we finish up, please pop them down in the chat, uh, we'll ask them and if not, we'll go through to closing remarks. Is there, is there anything that are speakers would like to say before we finish up? No, just, just thank you for the opportunity and good luck to everybody listening with whatever, whatever you end up doing in your future career. It's a, you know, it's a fantastic career. Um Yeah, I think everybody has tough days, but, you know, at the end of the day, it's, it's an incredible job, very privileged to do. So I hope everybody has the opportunities that I've had. Fantastic. And Michael, anything you'd like to say? Uh Just again, thank you for having me. I'd like to say that we had our first kid. Uh, my five year old straight out of F one. So we've got three kids at home. We're making it work. So it is doable. Um And thank you again for having me and I hope everyone enjoys a special episode of 50 Paces tomorrow. Fantastic. Thank you. Thank you guys so much and uh yeah, challenging Children and challenge a conversation I'm having with my wife and uh we'll, we'll see. But guys, uh that's for another time. Thank you so much for uh coming tonight. Uh It is very late in the evening and we still have quite a lot of people from earlier. Uh There's a couple of things I want to say before we finish up. Uh, the feedback form link will be in the chat at the end of the event. Uh It will automatically award your certificate, which is one of the reasons uh what made uh met also groundbreaking for the 6 p.m. series and why we still do all of our teaching through it is that you don't have to do these certificates. They just come like magic. Once you've done the, the feedback prizes for the poster will be announced over the next week and we have on demand content available and this will be available on the event page two next week. So definitely check it out with loads of events available. Uh I, I think, I think you will probably find something you like. Uh So yes, so that's it guys. Any last questions, anything at all, please uh let us know or keep the conversation going on Twitter or whatever social media handle you use and we will get back to you. Uh And yeah, thank you so much to all of our speakers tonight. I really enjoyed the evening and I hope everyone else has a great evening and uh we'll see you again for the next EYE VMC. All right.