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So good morning, everyone. Ladies and gentlemen, my name is and I'm the Social Media Officer of Aid. And alongside me, today is Roberta, the newly elected President of Aid. And together we will be co chairing this distinguished session of the A conference. Today is a profound honor as we welcome all of you to a at a we hold the conviction that surgical training surpasses a mere profession. It is a noble responsibility and a commitment to elevating the standards for the next generation of surgeons in our session. Today, we are privileged to present a panel of truly inspiring individuals who have surpassed expectations contributing significantly to incremental improvements in the ongoing upper trajectory of surgical training that we all pursue. Without further ado, I am delighted to introduce our first speaker, Mr Duncan de Mr Be is a consultant trauma surgeon and the clinical lead at King's College Hospital. Throughout his career, he has been a campaigner against violence and has co-founded the charity growing Sorry, growing against violence, which provides age appropriate education to school Children against the dangers of violence on the streets and online. Mr Be is also the chair of the Royal medical benevolent fund. The RMBF, the RMBF is a charity for doctors, medical students and families. They provide financial support, money advice and information when it is most needed due to age, ill health disability and bereavement aid is delighted to have chosen the RM BF as our charity this year. We welcome you all to try and snatch the last few remaining tickets for our gala dinner tonight and to participate in the raffle to raise funds for the RM BF. If you are unable to attend our gala dinner tonight would still and you, if you would still like to donate. We have created a just giving page and this will be presented on the QR code that will be available in Mr B. So without any further delays, I welcome Mr Duncan View to the stage. Mm Thank you very much for that. Very, very kind welcome and welcome to all the delegates here in the hall today and say hello to everybody online. You'll be pleased to know that it's raining outside. You're not missing the weather here. It's a real privilege to be here to represent the Royal Medical Benevolent Fund. And thank you very much to, as for all the support that you're giving to the charity, I just encourage everybody. If you would like to follow the charity online on Instagram or on X, please do engage with the charity and if you have any comments about things I'm going to say today please do. And hopefully you'll find this inspiring. The Royal Medical Fund is one of the oldest charities in the charity commission. And it has been funded for many years, originally, was set up to provide support to the widows and orphans of soldierss who went off to war. And over the years, it's had many, many challenges. You can question about whether or not we have a golden age in medicine or surgery at any point in history. But certainly we've got a very challenging time at the moment and it's a time of great change. And I think that quite often we have a sort of slightly inappropriate sense of our own immortality or mortality dependent way that we look at it quite often as doctors, we're quite ill prepared quite often if we get sick ourselves and we're quite ill prepared quite often financially if things don't work out quite the way we expect. So the RMBF provides benevolent support to both medical students and to doctors throughout training and all the way through beyond retirement. We have regular monthly grants and we have a grant awards committee and a really amazing team of assessors who provide support guidance and really supporting the process as well. Really importantly of people who make benevolent requests back to work awards. We really trying to help people to get back into the workplace and back to where they are with their families and the money advice service as well. We also have do health which is a confidential support line in conjunction with their and online resources as well. Quite often focused. I think in medicine on mortality isn't a hard end point. But quite often we don't talk enough about the survivors and particularly those survivors who have life changing consequences. And this is both physical and psychological. And I think it's really important that we recognize that and in the structurally violent and often very turbulent conditions that we work in. I think we really ill recognize the pressure that people are under physically, as well as emotionally. And we really see that through the benevolent work, we've had an increase significantly people presenting with mental health needs in recent years, about 15 per cent increase, particularly trainees and particularly doctors under the age of 30 with medical students quite rightly being from a much more diverse group than they ever have been before. We have a much more socioeconomically diverse group of medical students who are now faced with enormous concerns around finances. Many of my junior team at the moment, the medical students and with have debts in excess of 110 125 1000 lbs a year where they're basically just servicing the actual interest on the debt rather than the debt itself. And that creates huge pressure, particularly when people don't have generational wealth to fall back on within their families, really just living at the edge or beyond their means just to basically survive in many of the cities in particular where rents extremely high. At the moment. I think that we all bring to our workplace, our own lived experience. We all bring our own challenges that we've faced in our lives. But we also posed with challenges in the workplace itself. This infographic itself is regarding adverse childhood experiences. I think an awful lot of parallels with the challenges that we face both in terms of our own individual challenges, but also the challenges of the environment in which we work. And I was really encouraged and inspired with the discussions happening earlier on. I think that today will be a really interesting day in terms of many of the challenges that discuss today, in terms of how can we improve the actual working environment itself. So we can have an environment in which people can thrive, not just try to barely survive, we can really do our best to support each other in a kinder more supportive atmosphere. This concept of structural violence, the concept that the environment which we live in itself is itself violent and actually has consequences, is poorly understood by many people but is well established. And I think that you can consider it really as an industrialized disease for the Children who used to be put down chimneys, getting Potts disease. There's no point in just treating the disease itself. We need to actually work out why people are getting that and actually take them away from the harm that they are experiencing in the actual workplace itself. I think we need to this court from Desmond Tutu is extremely pertinent. We need to actually stop people falling the river to start with and actually prevent this and change the culture of working that we have not just to be able to address the consequences of it and quite often the consequences that present too late when people are already suffering and already literally falling apart really good online resources in terms of how we can work together, particularly for peer support systems proactively to improve our resilience and sustainability in the workplace. I just draw attention to the work of Neil Greenberg from Kings who has a website called March On Stress. This is a fantastic resource if you want to have a look at it with some really well researched and well evidenced programs for trim training for peer support within groups. And this has been rolled out in the military and lots of um clinical groups around the world. And I'd encourage you to have a look at this result. It's really, really fantastic but also the concept of trauma informed organizations, not in terms of the way that we listen and care for our patients in terms of the approach of what has happened, not what is wrong with you, but what's happened to you. But this idea of a responsive and listening organization that realizes what's happening, not just with the patients, with ourselves and our teams itself and then really invoke a constant change, particularly in terms of maintaining relevance of the support that's needed. Resilience is a difficult thing. I think. Then quite often, we suppose that actually the greatest stress in our organization is those who are actually at the coalface at the clinical end. But sometimes it's not the case in some of the major incidents that we experienced in 2016, 2017, 2018, many of the people who had the most lasting consequences in our teams weren't actually the clinical teams were, there were people who were absent, people felt guilty that they weren't there. There are non clinical staff or staff who weren't immediately engaged with the clinical process of looking after the patients with our housekeepers and with our porters and many of our staff who form really essential parts of multidisciplinary team who have relationships with our patients but aren't directly connected and perhaps protected with the sops of the clinical care that we're providing. And there's nothing worse as an enthusiast of being excluded from something and that sense that you should have been included and you're excluded is extremely damaging to people. So it's really important that we understand that both to maintain clinical focus, but also the sustainability of our teams moving forwards. So when we're in theater, we know that civility saves lives, we know that adoption of appropriate behaviors is really, really the key. And although we need to have good skills and good wherewithal in terms of our surgical knowledge and the skills that we have. I think that thankfully we have this now growing understanding, actually, human factors are incredibly important. And this year in the world, Surgical and Medical Safety Day, Martin Bromley Matthews said that this is the number one highest risk for us now in the medical profession, in terms of not really understanding human factors in the workplace and employ any of you to read his book, Black Box Thinking, which is a really fantastic book. I think a little bit slow to adopt this in surgery. I think the anesthetic college was the first to adopt understanding of human factors and just how important it is. And I think that we need to really supercharge our understanding of that and embed it in all of our work and our training quite often, the stresses of our work are sometimes brought out by major incidents and by huge events that happen. Um and it's not that these don't happen every day and they do, but the political focus and, and, and the media focus and the personal focus is quite often really intensified with it. And this is just an example of my own, which just I'd like to share with you the Grenfell um fire obviously was an absolute tragedy, not just an avoidable tragedy from a public health point of view. Um but also a, a tragedy for not just the individuals who very sadly lost their lives, 72 people from the tower, but also all those people who were injured, the entire community, the impacts of this will reverberate through um their lifetimes and beyond the generations. But I think it had a really profound effect on many of the first responders in the emergency services also in a slightly different way to some of the major incidents that we experienced in that year. Many of the other major incidents were like a really, really bad Friday night. Lots of stabbings, um high, high speed RTC S within a a uh an area that would normally have low, so to speak, collisions. Um This is a different type of phenomenon, er, and sometimes the senses involved with an accident like this, er, and a disaster like this, the smells, the sounds, the emotion of it and the insidious weather that it creeps up on you. I think it is something that we all recognize. These are my kids. Um This is them doing their predeployment training. Uh after the age of five, doing the basic skills, the mandatory training. Er, my wife was a hems doctor at the time and this is my er, daughter on the right. She wants to be a hems doctor like her mum. And I think that we often think of our team as being just ourselves and the team around us, we need to also think about our families and all of the people that these can be impacted sometimes by these events. I was clinical director at Kings at the time and I was involved as a trauma surgeon directly in many of the responses, particularly London Bridge and the Grenfell Fire. And not only was there a huge political process but also it was on the news constantly. And there was also a lot of political pressure and I'd been on speaking on radio for and I was on TV, and a couple of other things in interviews subsequently. And I was involved in some of the work helping with the community in the aftermath of the response. And I think that we sometimes think that uh our loved ones in our teams can somehow partition off our work from the rest of our lives. But it's quite difficult sometimes I think for Children and sometimes for ourselves to partition off the events that we exposed to and we do it clinically. I think if you, any of you have ever seen an accident by the roadside, that concept of just being out of that clinical environment versus being in the clinical environment and the way that you contextualize it is really, really important. I hadn't quite realized until my daughter, um the teacher at school said, would you like to come in and just have a chat? I thought that's great. I didn't really know what it was about, she said, Zara has been, has drawn this picture and she said it's the, the picture of the Grenfell Tower and it's the tower going up to heaven. And she said that she wants everybody to go to heaven together because she said that in the fire, they have been disfigured and if in heaven they won't be able to recognize each other. She was worried that they would be wandering around heaven trying to find each other. So she thought if they went to heaven together all in, at the same time that they wouldn't be able to, they'd be able to be together, at least in heaven. And this was really quite a poignant thing. I think, I think it's very emotional and I think that it really brought into context lots and lots of ways in which the, the loved ones that we have in our lives really are affected sometimes by our work. Um, the teacher then said, I've got about another 50 of these if you want to see them. So I think it's just an example that sometimes we do need to reflect just not in our teams, but in our families and everyone around us. The way that sometimes the impact of our life reverberates in the way that you sometimes don't realize. And just to have these conversations, not just with ourselves, but all the supporting families and, and the social infrastructure we have around us that support us in ways that we sometimes don't realize, I think this is true for many of the emergency services, there was a fire officer who I found outside the door, um, of our major trauma ward, uh about six months after the fire, um, really shot to pieces just asking if there was any information he could possibly get about one of the patients that he brought to the hospital. He didn't even know if the patient had survived. And some of that ongoing continuum of support and understanding of the way in which these things sometimes persist with people, particularly when people get PTSD and it creeps up on them and they weren't quite expecting. It is really important, I think to recognize and we need to have feedback loops within our service to be able to support people, not just in the immediate aftermath of instance, I think, but also for years to come for people who then come forward and disclose the experiences that they're having. So who's gonna look after you when the crisis hits you? So the RMBF over the last five years has paid over 2.5 million lbs in grants and helped over 800 people with financial and money advice. But we've helped over 1600 doctors in total and 350 medical students. And that number is climbing and we wanted to climb because we believe that there are many poor people out there that actually need support. We think this is just the tip of the iceberg. So we did some um work with uh UCL and did a AAA survey and a big review last year. And the significant reasons as to why people don't reply this sense of stigma, the sense of shame in being ill in the first place, just people not admitting to themselves, they actually need help. Actually, quite often, by the time they do, they actually, they're already in a crisis, they're already about to lose their homes. They already have their relationships that are falling apart and the sense of personal responsibility and sense of failure. Uh The sense of personal family, societal and professional pressure, I think is a, is really, really um huge and it's really uh ill recognized and quite often people just don't know where to go to help. Um Sometimes they don't think they're eligible quite often, particularly in patients beneficiaries who come forward recently who need to have support, particularly in post COVID with long COVID. The process itself, the actual process of embarking on the process is quite exhausting the process of filling in the forms, the process of getting all of that information together and just the courage to press the return and actually send the email. Even to realize that you've actually asked for that help is incredibly powerful and needs to be understood. So far more that we can all do not just to help to donate or to support charities in terms of the financial support that we need to be able to pass on to beneficiaries. But to break down the sense of stigma, break down that sense of shame and to open up those conversations, to be able to support people and to be able to sign people earlier, to support, to have better resilience in the beginning. But also when people are in crisis to be able to wrap around them and support them in the actual process itself, so we can do a lot of things, we can um present the criteria better, we can remove that stigma. And I think that we can do far more through word of mouth and hence the really fantastic contribution of having assets support the RM BF. Today, we're also starting very early. Um I worked with the Inspiring Futures Program and also other programs to inspire prospective medical students from all around the country. And I think that's really, really important. And I think we need to start early in terms of peer support because people quite often turn to each other within their peer groups rather than to someone more senior within an organization. And that's really the best way to get that information out there. And again, to destigmatize these things, look after your team. And I think there's some key messages and we need to work together not apart. I really believe that every interaction that we have with each other and with our patients is an intervention. I think we need to make every encounter that we have count. But I think above all, we need to put a light in the sky. It doesn't have to be a bad sign. It's a bad sign. But I think we need to inspire people and we need to give hope. And that's why I was so pleased to see that. Following on from my talk today, there's gonna be the silver scalpel award nominees and a whole lot of other inspiring people within surgery, but not just that, but this whole series of talks throughout the day, not just to train and empower all of you here today, but also to give you hope that actually, this is a fantastic profession. We should be very, very proud of it and it is worth hacking away at even when it seems like everything's going wrong and everything's falling about around you. There are people you can turn to support and we all need to turn to each other. Thank you very much. Thank you so much for this. That was an amazing talk and very inspiring and we do have some tickets left for our gala dinner. So please join us and, and all proceedings will go to this amazing charity. I'm delighted to now introduce you to the silver scalpel awards and the awards don't really need an introduction. I'm sure you all know about the silver scalpel awards um over the past 23 years. This award has become really legendary. Um It started as a vision of a past asset president David Regan who has grown this award with care and enthusiasm to what it is today. Um On behalf of the as a team and the wider surgical training community, I want to thank Mr Regan for his incredible work over the past 23 years and year on year. We encourage each one of you to nominate the best of the trainers who day in and day out work tirelessly to create the surgeons of tomorrow. This award is a solid fair process behind it to then fulfill the difficult task to choose a winner. All candidates are anonymized by name, gender and location to avoid any bias and candidates are also shortlisted by diverse asset panel and then she listed candidates are reviewed independently in multiple selection rounds and I'm so glad to introduce you to our silver scalpel 2024 lecture by Tamara Kiernan who will be joining us online. And Miss Kerner is a consultant oncoplastic breast surgeon in Liverpool and she was the silver scalpel winner of 2023. So I'll hand over to Miss Kerner who will appear on screen hopefully very soon. Thank you. Hello. Thank you for that kind introduction. Can you all hear me? Ok. Yeah, lovely. Um What a fantastic talk we've just listened to. That was absolutely wonderful. I'm so glad I was able to listen to it. Um I'm sorry, I wasn't able to make it down in person, but thank you to the asset team who've allowed me to be present today, albeit virtually. So I'm just going to share my slides. Ok. There we go. Hopefully this will move on. Yeah. So, II, do you know what I remember so well, being in Liverpool after being nominated for the silver scalpel and how excited and nervous I was back then. So I do understand how the nominees are feeling today. Um This sessions all about inspiring surgeons and the nominations for this year's silver scalpel are certainly inspirational. As are the people that we've heard speak today. I thought in this talk, I would take a look back at the surgeons who inspired me and why they inspired me. I'd like to encourage you to look at your trainers and colleagues and find inspiration all around you. I'd also talk about the things that you can do to inspire yourself and get the most out of your training and hopefully then to inspire those coming up behind you, things that we can all do to be an inspiration to others. So the first person who pops into my mind when I think about who has inspired me along the way is, and I even have a picture of him, Lee Martin. So Lee is a consultant breast surgeon in Lon in Liverpool. And anyone who knows him, I'm sure will have a little smile. On their faces as he's a fantastic character. I worked fully back in 2011 as a reg and we really clicked up until that point. I'd never really felt like I fitted in, even through medical school, I don't come from a medical background and I believe really strongly that we should enjoy life and maintain a work life balance. But everyone I'd met up until that point seemed so focused on their careers and working hard and it was all they talked about. And then I'm at Lee, he's a exceptional surgeon. I learned so many of my skills from him. But more importantly to me, he showed me how much he valued and loved the stuff around him and his trainees. And he taught us how to bring the fun in our lives. One of his favorite tests for a junior doctor was to ask them the name of the ward cleaner. Without her, we couldn't function properly as a unit and this would demonstrate to them that everyone matters and everyone is valued. We would have a team lunch every few months in theater when we brought all our favorite dishes in and we all stopped for lunch together and that would be the anesthetist, the O dps, the scrubs team. Everyone, we would share our food and we would have time to talk to one another. Other fond memories are of apple bobbing in the, er, theater bowls and hunting for Easter eggs. Around theater. Now, you don't specifically have to do those things and it's probably a good idea not to do them nowadays, especially don't hide Easter eggs on the top of the theater lights, cos that's not a good idea. Um, but for le it was his way of building the team showing them how much he valued them and rewarding them and you could see how much they loved him. They would work so hard to ensure that his list went. Well, he also took me out for drinks with his family, got me an invite, er, to an educational meeting in Barcelona, which was all paid for by industry and counseled me about only ever using your private work money for fun. I don't do any private work, but I still find this a valuable lesson not to rely on something that can disappear in the blink of an eye as a surgical trainer. I found the fantastic as he gave me all the operating and I mean, all of it, in fact, one day on my first day back for some leave, he said, do you know what tam? It's great when you're not here? I thought, well, do you know leave? That's a bit mean. But then he explained that it was because when I wasn't there, that was the only time he got to operate. And now I'm in that position and I completely understand where he's coming from. Cos I'm lucky if I get to scrub in, let alone do anything. Lee made me promise that when I became a consultant, I would do all these things for my trainees. So when I won the silver scalpel last year, I rang Lee and thanked him for all his wisdom. And I said, see I did listen to you. I think it's really important to feedback on areas of excellence. And it's one of the reasons that this award is so important and means so much to trainers such as myself. Another example I have is from a different consultant earlier in my career, when I was applying for higher surgical training, a consultant, I'd worked for three years prior, actually took time out of his evening to come and meet me in the hospital and to look through my application for ST three to make it the best it could be to get me that job, how wonderfully generous he was with his time for me. I remember another colorectal surgeon who taught me how to get the most of time in hospital, how to organize my day and be proactive about things. For example, completing a patient's discharge summary in theater, something I still do today. She showed me that I could take time for myself, have a family and still be a successful surgeon. What do all these trainers have in common? Well, they were great role models for me. I felt valued by them. They took me under their wing, made time for me and listened and I felt like I was part of a family. Something I think that we miss out on. Sometimes nowadays, every one of them tailored my training to what I needed and gave me the space to make my own mistakes, knowing that they always had my back and they were never let me go too far wrong. I'd like you to take time to think about your inspirational trainers and understand what it was that drew you to them and make sure that you do. You display those values. If you haven't already read it, I do recommend The Seven Habits Of Highly Effective People by Stephen Coving. It's not a new book. In fact, it was published in 1989 but has some really good tips in it about getting the most out of your day. One of the things he talks about in his book, which I would advocate is working within your circle of influence. So here you can see that your circle of influence and then everything outside of this is beyond your control. The circle of influence is the green and everything outside of that you can't control. If you spend your time thinking about or working on things outside your circle of influence, then you're just gonna get frustrated, exhausted and you're not gonna achieve anything. However, if you concentrate on things within your influence, then you'll achieve so much more and over time. What happens is that circle increases in size as trainees, you may feel that you have no control over your day at work with all the rot and ins and outs, et cetera. But in actual fact, you have an enormous amount of influence. I would encourage you to take a look at something that's bugging you and think about what you can do to change it. A good example that I can think of is something that happened in our hospital. Last year, the higher surgical trainees were complaining that the rotor was such that they were missing out on their training lists. Continuity and patient care wasn't great and morale was down. So my question to them is what are you going to do about it? And initially, I got, well, the they won't listen to us, what can we do? But then bit by bit, they realized that they could do something if they all got together. So eventually we got to a point where there was a meeting with HR the CD and the trainees together. And prior to that meeting, the trainees had all got together and prepared a statement on how their jobs were not meeting their trainee needs due to the rater, they'd looked at the logbooks, they looked at the missed lists and then they took the next step and proposed how it could change, super proud of them because by the end of er that statement, there was no way that hr or CD could say no, it was a win win situation for everybody. Cos the consultants got the trainees more often. Uh The trainees got to go to the training list more often and it was a big tick from HR cos it met all the time requirements that new rota is now in place and it's freed up more trainees to get to those lists. The work that those higher surgical trainees did together didn't directly help them as the rotor came into effect after they left. However, it has affected the trainees coming after them. And isn't that what we're all meant to do? Leave wherever we go a little bit better than when we started the seven habits that CO V advocates and describes are instead of being reactive, be proactive, look for things that need to be changed and then go about changing them. You need to know where you want to get to. So you need to have a goal and then once you have that, you need to look at prioritization and plan. If you're able to think of an outcome that will benefit all stakeholders, you're much more likely to get that through. And then we do need to understand somebody else's viewpoint before we can argue our own. And before we can make changes, once we've done that, working together and you'll get so much more done and then sharpening the. So now what that talks about is working on yourself and that might be physically, it might be your mental wellbeing or it may be learning new skills in his follow up book Covy, put an eighth habit in and that's find your voice and inspire others to do the same. And I think that's what conferences such as this do. So if you think about the example I just gave, they did use all of, well, most if not all of those habits to affect a change on the rota. Now think about something you've tried to do that wasn't successful. Maybe some of these he habits could help you in the future. Now, let's sharpen that sore. So firstly, we need to take care of basics and that's getting plenty of sleep eating, well, taking exercise ideally in the fresh air and then we need to take care and give time to our nearest and dearest because only when this foundation has been completed, are we able to work successfully on our career? What about making the most of your time in training? There's evidence to show that yo, those who use visualization, increase their skills and it's mostly shown in athletes. However, it's just as valid in surgeons. In fact, what is even better than visualization is cognitive simulation. We're all OK with simulators for surgeons, but even the highest fidelity simulators are not as good as your own mind. I've been doing some work with SLAA and Sonia Basler, looking at the use of a cognitive simulation app in teaching trainees operations or parts of operations. The results of this project should hopefully be published soon. The app is free to, to, to download. You just have to set up an account and then there's videos on there to show you how to use cognitive stimulation to improve your skills. As a consultant, I use it regularly before an operation to practice steps and to plan what I'll do in the event of a complication si within cognitive simulation. You don't just think about the operation. You do it in your mind. You use all your senses, you might feel the cold metal of the scalp in your hand. You can smell the diathermy, hear the monitor, feel the warmth of the skin and how it gives with some pressure under the knife. Please give it a go. It's as I say, it's free to download and all the feedback that we've had so far has that it's been really useful. Now, the use of Cox is of course, in addition to making the most out of every minute in hospital, working with your fellow trainees to ensure that you get to all the activities that are gonna benefit each of you the most that could be looking at the theater lists or clinics and planning, who is going there operating together or swapping on calls or days off at the start of the day state, what you want to achieve out of it. It could be an operation that you particularly want to do. It could be part of that operation. Ask for feedback, constantly, do your work based assessments and use them as a way of structured feedback. Bring up discussions about topical points and get yourself favored at every minute of the day. When you try to explain things to others, it suddenly becomes very apparent if you truly understand it or not. So I'd suggest testing yourself, teach the medical students, teach the juniors, the nursing staff, the cleaners. It doesn't matter who just talk to everybody and anyone and that will inspire others. Then the other thing you can do is look around you and find the people that are rooting for you. There are plenty of us often in extra role such as surgical tutors and TPD S, but there are plenty of consultants without those extra educational roles who will act as a role model and a support for you, maybe see who pops up on your A R CPS cos that's usually a clue. Talk to your fellow trainees, come to conferences such as this. It's really important to build up your networks and know who you can call on above all, do not be afraid to ask for help. Lastly, how can each and every one of us be an inspiration to others? Well, I've already talked about role modeling, think about how you come across. And is that how you want to be thought of be human? Talk about your challenges. It could be clinical training, personal, how have you addressed them? How have you overcome them? It's so important to show those coming up behind us all, all around us that we all make mistakes. We all fail from time to time. But it's how we respond to these challenges and failures that makes us stronger and better. We must pe treat people with kindness and always be civil no matter how stressed we are, we must remember this due to the effect that instability has on everyone around us. Its effect on surgical skills has been well documented in the literature, but it actually affects anyone that has even witnessed the event and there really is no excuse and above all have fun. And if that me means wearing a shiny disco helmet and dancing around before clinic, then go for it. Don't take yourself too seriously and please make time for those around you. It may be that some of you do all of those things that I've talked about. But I hope I have inspired some of you to make some changes or maybe take a look at the things I've mentioned today such as the coin. Thank you once again for having me at your conference. Good luck to the nominees for the award giving tonight. And I really hope you all have fun at the dinner and I'll stop sharing there now. Thank you so much for your talk. That was really inspirational. And I hope you feel the same in the audience. I'm looking at our conference coordinator who will probably not be happy with this. But does anybody have any question? We've got Miss K in here so we can ask one question? OK. So I don't know if you've heard the question. It's a difficult one. How do you manage to sort of split your mental emotional energy, time to have time for your trainees, your patients, your friends and family and yourself to not to avoid burnout, emotional burnout. I agree. It's, it's incredibly challenging. Um, some of the things that I found useful, certainly to ensure that I take time for myself and my loved ones is actually to diary things. So I will book appointments for myself to spend time on exercise or to spend time with relaxation. I don't do on calls, which is beneficial. So I make sure as much as I can, I don't do anything work wise at the weekend. And in terms of the trainees again, I book them in. So I make sure that I have time dedicated in my S pa time for the trainees. Um, every moment that we have in the clinic in theater, we are training the whole time and then we book time in to reflect upon those. I hope that's helped, but it is very difficult. Er, but u the use of a diary and blocking out time, I think probably is the best way that I found around it. Thank you so much for your answer. Um Well, now move on. Thank you so much for joining us. You're very welcome to stay on um and watch the next session. Um We'll move on and really introduce you to the Silver Scalpel nominees of this year. Um And as you know, we've got six nominees each year and we're very happy to have four of them here today um to have sent their apologies, they couldn't join us, but um we'll be naming them and reading a quote from them and just to keep inspiring you. So, um we will start with Professor Jim can, who's a consultant colorectal surgeon um at Queen Alexandra Hospital. And what we've asked all our um nominees is to just tell us what they like about training, what inspires them and what their philosophy of training is. So hopefully there will be helpful tips for all of you and for your trainers as well. Thank you. Thank you, Roberta. Good morning. All absolute player to be here today. Really excited to be a nominee for a silver scalpel award, which to me is the real red carpet Oscars equivalent of surgical disciplines. My relationship with surgical discipline goes over 25 years, pretty much as long as I've been married and believe me, my wife is still very jealous of that relationship. Um II was very fortunate to have worked with some key trainers and key figures in colorectal surgery, which is my discipline throughout my career. And I always admired if I could be half of the person that they were, I will feel very accomplished. So it is important to look up to your inspiration, to see what you want to be in life and try to see what they do well and try to learn from that surgery is a changing dynamic speciality and lots of changes have happened and a much more rapid change is going to happen over the coming years. And what we need to do is to be flexible, innovative and adaptive to that situation. Surgical training is something is very close to my heart. It's a passion of mine as well and I think it can be done in so many different ways and I still don't think that I know a lot about it. I'm still in the learning phase. So to say, I believe as a trainer, you have to be subconsciously competent. You don't have to think about what you're doing. You need to be really good at what you do. That's the base. Then you need to have the interpersonal skills to be able to understand what your trainees needs are. And how are you going to deal with adult education at various levels? I have taught people who are twice my age older than me and I've obviously taught medical students and junior doctors as well. You can't treat them in the same way, same fashion, you have to have the ability to tailor it according to their needs. So for example, training a senior trainee or a consultant in advanced mis or robotic procedures, I would be thinking my role as a professional coach or a manager of a football or a sports team where you look at somebody's practice, see what they're doing, understand it first, then start tweaking it a little bit so that they can get improvement. You don't want to change their game completely because they're already established or they have a way of doing it and there may be many ways of doing the same thing. So that's really a fascinating role of observing people's practice. And I do that with my fellows and trainees when they start to just see them first, what they know already what they can do and then try to change little by little every time because too much change can drastically damage their practice, confidence and skill set as well. So that's a fine balance there. But on the contrary, if I'm training a young trainee, a medical student, early career ST trainee, it's a different need. Have to give them education knowledge. You have to inspire them as well to remain involved in the game. You have to have time for them to sit down and understand what their needs are and, and, and, and give them a role model for the future. So, so there could be different needs for various stages in your career. I strongly believed in breaking down complex procedures into small steps. Learning is a lot easier, a lot more fun and you can train more people at the same time. If you do that, call it moderate training. It's a concept is not new, but you break down a rectal cancer operation into 10 steps or five steps and teach trainees and fellows 12 step at a time and then assimilate it. I'm very proud. We just published a paper last week in DCR is coming out looking at long term cancer outcomes of patients treated by trainees and fellows in robotic rectal surgery versus consultants. And there's no difference which is a testament that if you train people well, they can achieve same, same results. We all know what the challenges surgical training is facing right now. And I wouldn't create those. I would want to look at the solutions. And I think going back to the point, I think we need to be flexible. We need to be innovative and we need to be considerate for the trainers out there. There are not many, but there are few on the stage here. I would always say that don't underestimate the power of these trainees. This is a different generation. We all say that we were the best trainees in our times. But I believe me, you guys are much better than us at so many things and you have so much passion and energy and we need to harness and channel that in the right direction for the trainees. I would say, please, please, please don't take your eyes off the focus, which is the foundation skills that you need in surgery. Surgery is a beautiful craft speciality and has so many facets how you can learn it. But if you are in a rush and if you cut corners and if you get depressed and disappointed that I'm not getting access to robotics training or advanced surgical training, your time will come and you will accomplish that. But don't underestimate the value of good foundation skills if you have the principles, right? If you know the surgical principles what to do and more importantly, what not to do, and you just can observe that by looking at practice around you, finding the right mentor, finding the right trainer to go and talk to them and learn from them. If you develop those building blocks, well, you, you will be amazed as to what you can achieve in your life. So I'm very positive that the future of surgical training is pretty bright. We just need to be more innovative, more flexible and adaptive. Thank you very much, very much. Right. Hello. Hi. So next up, um I would like to invite um Mr Nicolaus Costula, who is a consultant thoracic surgeon at the Golden Jubilee National Hospital um to give you a piece about surgical training. Good morning, everyone. We are living in a, in a period of time that the science tries to prolong life. Uh I was reading the other day that uh dying will be an option. Uh We're very lucky. We are doctors, we are surgeons, we are trainees and we have the opportunity to prolong our, our life in a different way through our trainees through you. I'm coming from Greece and the Acid Greeks. They were believing that uh one of the most important values is to maintain fame after death. If you read Homer, it is very, very common value in his manuscripts. Uh How we can achieve this in surgery, we can pass knowledge, we can pass skills to the next generation to you and you can pass it, you can use it, you can develop then further, you can pass it to the next generation. And this is how we gain fame after death. The reason II enjoying training is because I can leave this legacy behind. I can teach knowledge and skills that people can use, can find uh user can develop, can pass to next generations. And hopefully they will remember me as a decent at least trainer. At the same time, I have the opportunity to act with uh fresh brains like yours. Strong brains, thirsty for knowledge and uh bra that can teach me things. I still uh learn things from my dreams. Yesterday, I learned something that I was not aware of. Sometimes I consider trainees like uh babies, babies, they come into life. And when they do their first steps, suddenly they want to run, they want to run and they cannot even maintain their stability, which is interesting because they have fire. They have passion, they want to explore life, they want to explore the world and uh they have uh a fresh healthy body to do this. They have very strong hearts and uh they have the support and the care of their parents who protect them from falling equally trainees. They have the enthusiasm, the fire to, to explore, to develop the specialty, to develop new techniques, to pass these techniques to other people, to become consultants as soon as possible. And uh of course, they have the physical status to stay in the theater. And you know, of course, hours after hours they have the passion, they have the facilities, the resources and the first brain, as I said earlier, particularly, they have type of parents in host. These are the trainers and our role is to, to contain somehow this fire to control the passion, but not to extinguish completely because uh we need your fire. We need to allow an element of uh let's say experimentation, an element of eh eh you trying to develop new things. Our role is to filter bad knowledge. Nowadays, uh you can just uh log in the internet and you can download papers books, you can read, you can watch videos in youtube in reality. Some people think they can become citizens without even being in theater one day. So our role is to filter all these things because there's so much bad, no links are out and there are so many scandals happening every day and we need to be sure that we're going to teach you uh tricks and tips to make your surgical life and career safe, effective for your patients uh enjoyable and is going as possible, which sometimes is not, our role is uh as balance for you is really to, to take care of you, to protect you and uh to inspire you. I have my own trainer who inspired me so much in life and uh he died last year. Uh This person really gives me a lot of skills knowledge that I pass to my trainees and I mess with the name uh every day and I hope they will take these skills and they will make it better. His name is, he's uh my silver award and he gained fame after death. I wish you the best for your future and thank you for giving me the honor and opportunity to be here. Thank you so much for another powerful speech. Um We'll invite Mr Mattia Kovich who's a consultant orthopedic surgeon at Edinburgh's Hospital very much. Thank you very much for inviting me. Good morning everyone. It's a great pleasure to be here and it's very difficult now for me because I will have to repeat almost everything those two gentlemen just said, but II will try not to. So II base my teaching on on two purpose or two principles. One is to give uh trainees opportunities. So basically as a train trainer, it's important that we allow people or that we create opportunities for the trainers, uh trainees and then they take it or not. It's, it's up to them. It's very difficult to police uh adult people. I tend not to police adult people uh to, to get the either the job done or to progress to the next stage. But the next even more important thing is that I found that if I allow the trainee to go home, unsatisfied with the task, they were kind of completing or failed to complete on the day, they not just haven't lost that this training opportunity, but they have lost quite a few more days because they feel I I'm not good enough. I'm, I'm, I'm, I'm a failure. So II spend a lot of time too and that this really relates to what Jim said is that we, we compartmentalize the teaching so that we will allow trainees do the teaching, they, that we know that they can complete and they can go home satisfied with the with the job. I think this is way, way the most important thing we can offer to trainees. Um Everything else is, is on on top of that, which is also important. But if I notice that if goes home, they satisfied, they also they start asking questions next day. And after maybe even after uh next week, they say, oh, I'm very so incompetent or so, then basically, you need to reassure them that this is not the case, but even better than reassure them in retrospect, is better to allow them to build the self confidence. And this is my main task when, when I'm looking after training and I hope that you will all enjoy your training and complete your training with the least of uh feeling bad on the day. I'm sure there will be days like this, but hopefully the the smallest possible number and I wish you all the best in your future career. Thank you so much. Um What we'll do now will before we go into Mr Brewer, we'll read um the kind of quotes that we have from Mr Dward and uh Miss Lloyd Hughes. Um So we'll start with what Mr Ward said about his nomination. Um I'm extremely humbled to be nominated for this prestigious surgical award and thank my trainees enormously for this great honor. Never. Has it been more true that no training today means no surgeons for tomorrow. Now is the time to focus on training value and work with our trainees to maximize its productivity and enjoyment. So I'm just gonna say a round of applause for Mr Dart who's not been able to join us today and we move on to Miss Lloyd Hughes who's a consultant, plastic surgeon, a guy in Thomas NHS trust. She says I'm very passionate about teaching and the well being of our trainees making sure they're treated fairly, being trained, making progress and feeling valued. So, again, a round of applause for Missy Hughes. Right? And um last but not least, I'd like to invite Mr James Brewer, consultant, upper gi surgeon at Chelsea and Westminster and trust um to talk a bit about surgical training. Thank you very much. Excuse me. Every surgeon should have a favorite instrument. Here is my needle holder. I wanted to bring my, our robot here, but obviously they wouldn't allow me. My name is James through and I'm a, a surgeon and a trainer. I also have a background in engineering, hence my fascination for instruments. They extend our capability and our reach, but instruments are becoming more and more complex. They're even learning by themselves. A I is learning not from repetition but from variety from V variation, just like you and me variety is what makes training in the UK. The model of training in the UK is so special. You rotate through many units and many centers through your training. And that allows you to be exposed to the good. They're not so good and the accident, excuse me. And then I think this is key. I think being exposed to all of this is key and invaluable. And then one day you rotate through our unit for a brief period, maybe six months or a year. And I get the privilege of contributing to your journey. I try to teach you that we have the best job in the world. One that includes two very exciting qualities, critical thinking and movement. At the highest order as a trainer, I often think of my surgical heroes, my, my trainers, I've, some of them have retired. Some, some have passed and I feel I am an extension of them being here and having the opportunity and being honored for my passion and ability to train means if when I was nominated for the silver suture award as a registrar and now nominated for the silver scalpel mean means really more to me than any other professional achievement. It also honors my trainers to whom I am incredibly grateful, but I have many trainees here today. So I will tell you a secret as a surgeon practice, this have one intention, make one move leading to at least one result, incorporate this into your every thought and every move from the moment you step into the operating theater, take it beyond the Braden Theater and you are likely to surpass your own heroes, your own trainers. This is what I want for you. You see you are my favorite instrument, one that is alive, that has compassion, curiosity, and incredible talent. You reach, you extend my capabilities further than any other instrument. Thank you. Thank you so much for all of your speeches. And I wish we had time for questions, but they will be around today and they will be coming to the gala dinner. So please feel free to ask any questions and I'm sure they'll be very happy to answer any questions you will have. So again, thank you very much. And we are really grateful as training to have people like you that inspire us and help us to develop and we're so happy that we're able to celebrate you. So, thank you very much.