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Summary

This highly engaging on-demand teaching session, entitled "Refining Culture and Surgery," focuses on identifying and combating sexual misconduct within surgical practices. Spurred by a paper written in 2021 discussing this topic, the session will be facilitated by several individuals with backgrounds in surgery and sexual misconduct research aiming to catalyze significant discussions and reforms within the surgical field. Participating speakers include general surgical trainees Greater MCL and Rebecca Fisher, who will share the results of a crucial project and the ensuing discussions about sexual misconduct in surgery. Additionally, they extend upon discussions related to the prevalence of sexual harassment and assault in the workplace in recent years, particularly in light of the Me Too movement. The session will serve as a platform for encouraging cultural change, promoting safe work environments and better education on acceptable behavior, and calling for stringent policies and conduct codes. Attendees will gain crucial insights into a troubling, yet significant aspect of the medical sector, motivating them to stimulate positive transformations within their respective organizations.
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Description

Welcome to our ASiT annual conference - we are delighted you could join us!

A couple of things that might be helpful for you to enjoy the weekend:

  • If joining online - the main stage is being streamed (breakout sessions are for in person attendees only)
  • There are some networking sessions in the breakout - please do pop in at break times
  • Use the chat to ask your questions - the team will do their best to get them answered for you
  • Share on socials by using #asit2024 and #TheTimeisNow
  • Take a look at the sponsors and poster hall area

CALLING ALL ASPIRING SURGEONS!

Join us at the biggest surgical pan-grade, pan speciality event!

  • Unveil cutting edge research presentations
  • Engage in informative breakout sessions
  • Be inspired by captivating keynote speeches
  • Enhance your skills in pre-conference workshops
  • Elevate your career with expert career development insights

All UK & Ireland tickets can be purchased here: https://www.asit.org/conference/overview

Learning objectives

1. Understand the prevalence and nature of sexual misconduct in surgical settings, as evidenced by recent research and surveys. 2. Recognize the various forms of sexual misconduct and the impacts they can have on victims within the medical workplace, with a focus on surgery. 3. Become aware of the existing systems for reporting sexual misconduct and why they may not be fully effective or utilized as much as they should be. 4. Learn about the recommended changes and policies proposed to address sexual misconduct in surgical settings and support victims. 5. Reflect on personal attitudes and behaviors related to sexual misconduct and identify ways to promote a safe and respectful work environment for all members of the surgical team.
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Computer generated transcript

Warning!
The following transcript was generated automatically from the content and has not been checked or corrected manually.

Hello, everyone. I hope you're enjoying the conference. So, um we are in the next session. It's entitled Refining Culture and Surgery. So I am Michael. I'm the Equality and Diversity Officer for Asset. I'm the newly elected Director of Education and one of the executive committee members, communications officer and newly elected uh associate honorary secretary. Really excited to be part of the session. I'm sure it leads to some really good discussions following the presentations. So I'll leave it with you. Thanks. So our next speaker is going to be Miss Greater MCL and Miss Rebecca Fisher. Good afternoon, everyone. Uh Thanks for coming to one of the last sessions of the day. We appreciate the commitment that you've got um particularly when other activities are calling. My name's mclachlan. I'm a general surgical trainee in Kent in Sussex and I'm the trainee lead for the working party in sexual misconduct. My pronouns are she and her and my twitter or ex is up on the slide. Please feel free to tweet. My name is Becky Fisher. I'm an ST three in general surgery in seven. I'm currently skiing off doing a phd at the University of Manchester looking at uh gender differences in surgical training. Um I uh my ex is also up there and my programs this year her as well. So we're going to talk about um progress with the working party um on sexual misconduct in surgery. Um With this presentation, there's obviously a trigger warning. We're going to be talking a little bit about the results of our project, but there will be no specific cases um or stories in this presentation. So, um, this is, I think the third time we've kind of, uh, we've come to asset to talk about this topic. Um This particular wave of sexual misconduct work to some extent started with a paper I wrote with Simon Fleming in 2021. I perhaps was a serendipitous invite because I said yes and 20 other women said no. And it was only because I was in a very protected and small unit who looked after me that I felt able to write. So we wrote that paper, it got a little bit of traction but things really took off. Um, um, when Philippa wrote her account, um, uh, a brave account of her um, experience of sexual assault and surgery. Um, now that she is more senior, um, and then this sort of started a, a torrent of more reports coming online, more news stories and more interest. So an independent body was formed called the Working Party on Sexual Misconduct in surgery. And, um, it's an independent group of surgeons, including consultants and trainees, organizational psychologists and specialists in sexual misconduct research. So, although there's been some recent focus in our workplace, um recent focus in the wider press has been going on for a few years, particularly since the me too movement. And it's clear to see that it's not new to medicine either. So here's just a few snippets of, of quotes from our profession, people calling it out over previous years, notably in 1992 a paper in 2001 and then a very specific one in, in our bulletin in 2018 that said in terms of sexual harassment, male surgeons touching women, I don't think that's happened in 20 years. I'm not saying it doesn't exist, but it's not a major feature in the UK. So, Sim and I possibly disagreed and so we felt that we needed to get evidence base in order to make some action. So the um this paper from our team was published in September last year. Um And thankfully made the press um because of its quite harrowing results, um you can have a look if you've not seen it before through the QR code there. Um So we have 1700 participants of which 400 provided sufficient data to be included in the primary analysis. Proportionately more women responded. They were 53 per cent of our respondents compared to 28 per cent of the workforce overall. Most were doctors with some dentists and 10 per cent of participants were anesthetists because we wanted to capture the surgical team. It was mainly consultants who was possibly indicating that there were more, they were more confident coming forward than trainees. The two largest surgical specialties had the highest number of participants. As you might expect. Our results showed that sexual misconduct is a highly prevalent experience in the last five years. Among our respondents, 63% of women reported being the target of harassment and 30% were sexually assaulted. In the last five years, vast majority of both men and women had witnessed sexual harassment. But we saw women were more likely to be both witnesses and targets and all these gender differences were statistically significant. We asked more detailed questions about witnessing or being the target of specific experiences. For example, 53% of women had been the target of the sexual joke in the last five years. Compared to 16% of men, 40% of women had experienced uninvited inappropriate comments about their body compared to 10% of men and 30 but 7% of women had experienced another person deliberately infringing on their personal space. And compared to that 37% 0 men reported this to go further. 11 per cent said of women said they had been forced to partake in physical contact in exchange for career progression, which is a form of sexual coercion. We also collected a large number of comments um which are currently undergoing qualitative analysis handed over to Greta. So we also asked about whether or not people reported these acts of crime. Um And we also asked why people didn't. And actually the results are things that we all know about. There was a fear of being accused of over reacting, of being sensitive, of not being able to take a joke of being a snowflake. There was a fear that it didn't seem serious enough. And actually, interestingly, some of the anecdotal evidence that we got during the survey because we gave very clear definitions of what sexual harassment, sexual assault and rape entailed. There are a lot of people that had a light bulb moment where they realized what had happened to them was legally classified as harassment or assault. Most people understand the premise of rape, but the harassment and the assault was the real light bulb moment for a lot of people. So I think that culture that we have created in surgery is one that minimizes this behavior and creates a norm of these jokes or this banter or these comments and this deliberate infringing and ensures that those victims and survivors of these behaviors don't feel confident to speak out about it since the publication, we have had national news front page of the Times there. We've been in the top five per cent of all alt metric research output. The health and social care committee has commented on this. And we've given evidence that the women and Equalities select committee. We've also made international news and we've had strong backing from all of the Royal colleges that this type of behavior is not to be tolerated and that our culture that has permitted this, that has accepted this behavior needs to change. We also published a report at the same time as the paper which called for 15 recommendations. These covered these five topics of implementation and investigation, policies and codes of conduct, education, culture, and accountable organizations and data collection. Now, the implementation and investigation called for a national implementation team to ensure that these recommendations were put into place. The investigation, part of that was to have an anonymized independent reporting and investigative team that could come in and look at these uh incidences of sexual misconduct. The honest truth is there are systems in place for reporting this, there are hr there are educational sources, there's lots out there for reporting bullying, harassment, racism, but we know from our data that people don't use these or don't feel safe using them. We also don't know if they actually are working. Unfortunately, a lot of the time when people report these behaviors, the perpetrators of these crimes will leave trust, be fired, retire early or stay in post. And actually a lot of the time that isn't fed back to the victims and survivors. So we don't know if we are actually getting rid of these bad apples inverted commas. So even if we are, there is a perception that these systems aren't working, which means that these systems are not being used. So we need to have that anonymous, that independent investigation because we also know that people that perpetuate these crimes like positions of power, they like to be in control of the culture of that organization. So they tend to be drawn to positions of leadership where they can maybe change things in their favor to allow them to carry on performing these acts. We need to have policies and codes of conduct. We need to know and have it. Sadly written down in black and white, what are acceptable behaviors for surgeons? What are acceptable behaviors at conferences at work place events? The BMJ and the Guardian did a huge investigation just prior to our publication that found that less than 10 per cent of trusts have got policies in place that specifically relate to sexual misconduct. If you haven't even got a policy in place, how are you expected to take these crimes seriously? There needs to be whole scale education across the board at all levels. University level, junior doctor level consultant level about what these behaviors look like and which ones are not acceptable. We need to have culture and accountable organizations in particular, the CQC, we'd like them to take on board, any data collection that is done in this area and have that fed into the rankings that hospital trusts have because again, that will make NHS management sit up and take this seriously and we need regular data collection on this because whilst we've got a snapshot of where we are now or have been for the last five years, we need to know where we're going and of possibly counterintuitively that number we would expect to increase as the awareness increases. As people have a psychological safety about reporting. We're not the only people in this space doing stuff surviving in scrubs is also looking at this. They've been collecting in anonymous reports from people that work in surgery in health care and project S is another place for reporting sexual misconduct in the. We have had some successes so far. The NHS staff survey has included questions for the first time in its in existence in relation to sexual misconduct. NHS England has sent out letters to the integrated care boards and trusts stating that this behavior is to not be tolerated. The NHS Sexual Safety Charter was launched just prior to our publication that speaks to 10 recommendations and implementations that trust should have in relation to making work a safe space. The GMC and its good medical practice update has specifically called out bullying harassment and undermining as unacceptable behaviors and has called on those that witness them to speak up. There will also be questions in the GMC National Training Survey in relation to this but more needs to be done. I want to focus for a moment on jokes with sexual content. We've all heard this term, haven't we? It's just banter. It's surgical banter. Oh, you can't take a joke, darling. Stop being so sensitive. Well, Romney QC that did an inquiry into sexism in the BM quite categorically says that it's not banter if there's a power hierarchy. John Skinner, the ex president of the British Association of orthopedics all says that it's not banter. It is. In fact, homophobia, racism, misogyny and sexual harassment. We know from Ross works who's in the audience that people start off at low level interventions and little jokes and they test the waters. People don't go out and just steal 200 million lbs worth from an organization. They start off with a tenner, they see what they can get away with. They test the boundaries and it's the same with sexual misconduct. Most perpetrators of these crimes don't go out and just rape somebody. They start off with some jokes, they change the social norms and the microenvironments and the micro cultures that you work in to test the waters of what they can get away with. So it's more than banter and we need to be aware of that and to quote the London ambulance service, other types of Banter are available. So we're surgeons, we like to have action plans, we like to know what to do. So what can we do as trainees? Well, we can reflect on our own banter in the work. What would, what are we saying? Would make people feel uncomfortable if the patient was awake? This is from Clare mcnaught earlier. How would we, would we still say those comments? You need to be able to call out jokes but also call them in. It can be quite confrontational, calling out a boss and a joke that they've made. But you might feel comfortable saying to them later on in the coffee room. Oh, that joke made me feel a bit uncomfortable actually. Or II didn't quite get it if you're a bystander, try and support the victims as best. You can think about reporting once we're in a safe space. If you don't feel safe at the time that this happens, you need to ask your region for bystander training, unconscious bias, training, clearer policies on the matter and also push for local changes in line with the recommendations that we've made in our report because that's how change happens. It comes from the top down and it comes from the bottom up and we're all part of that solution. Thanks very much. Thank you very much. Great. And Becky, do we have any questions from the floor? They will bring you a mic in a second. Thanks, Olly. Hi. Um Thank you so much for that talk. I just had a question regarding the independent kind of investigation that you mentioned when you say independent. What does that mean? Is that independent from the trust from the NHS or because I think it has a lot of effect on people who would think about reporting per se. And um to what level does that information gets kind of fed back to their own employers? I think ideally it should be almost independent of everyone. The Royal College of Surgeons has a sort of invited review. If you've got concerns about clinical safeties, clinical safety issues where a team from the college goes in and looks at numbers and does data analysis. There should be something similar for sexual misconduct and again, in Australia, that are a bit further ahead of us in the psychiatry world. If they get three anonymous reports of bad behavior in a hospital, then there is a team that goes in and investigates it. I think it needs to be independent from the trust themselves because as I say, as we know people that perpetuate these crimes tend to go into positions of power because it enables them to keep on doing this behavior. So you need to be able to circumnavigate that who it would fall under TBC, who would fund it TBC at the minute. I think that is the vision and the wish. Um And I think there's the evidence backing behind it. But again, with anything that comes from cultural change and organizational change, it doesn't really happen overnight. Thank you so much. Uh There is one more question, I think last question, what happens when the person that you go to says it's not worth the fight. Who do you then go to? Um I think that's a completely valid, valid issue and a lot, it's a reason why a lot of people don't report at the time. Um And of course many of us in sub subspecialties, no matter who you go to, it'll be the same people, everybody's friends. We all meet each other here from very early in training. Um I think it's trying to cast the net wider and think, think more broadly so within your trust, whether that is a freedom to speak up guardian, whether it's somebody like director of medical education or somebody with some role that is sort of at a tangent to where you are, then of course, there's sort of at a deanery level if you're a trainee at a college level. But I think our main point is that this is the problem is that often our direct point of call that we kind of tick the right box at SJ that we speak to our clinical supervisor and then we speak to our educational supervisor that doesn't work because sometimes your clinical supervisor is married to your educational supervisor or they're the brother of your training program director. So yes, we're working on it. But I think it's a case of think laterally and it may be that you have to go to somebody of power in a different specialty and it may be that you have to do these things in retrospect when those people are no longer have power over you. And once you've got your I SCP sign off and then you can go back and do the right thing for you. And also to add to that also think about people outside your region. There are plenty of allies that are in equally powerful positions that will not stand this nonsense. Who can come down like a ton of bricks on people or, or just give you the support that you might need depending on what you want to do at that point. Um So do as Bey says that that tangent of who else is there, who else is on social media talking about this? Who is on linkedin? Um who have you met at a conference that might be able to give you some direction. So always think about you're not on your own and this um and it's really about using those networks and those people that might have other thoughts and other perspectives and also sorry. Um Because of the nature of it, um What was I going to say? Never mind. It's gone. Yeah. Thank you so much for answering these questions in such great that uh I think it's so important talking about these things because only through discussions, we can move forward, talking about these difficult topics, the difficulties that we face because these are small steps but we're making progress. So, uh, yeah, thank you very much. Next up, we've got a talk on alternative approach to fellowships, Miss Fatima Monzo and Miss Maria Sterling. Thank you. The floor is yours? Good afternoon, everyone. Welcome to our session. So, this topic is a bit different. Um, you might ask quite how it fits in. So we're gonna introduce it to you slowly. So, my name's Maria Bland. I'm Sterling. I'm a surgical trainee in Edinburgh. Um I'm currently ST seven in general surgery and I'm here on behalf of the RCs trainee committee. Hi, my name is Fatima Mansour. I'm an ST five registrar in the West Midlands scenery with a subspecialist interest in HPV and transplant surgery. And I'm also an R CSE D trainee committee representative. So we're here mainly as part of our well being week which we're currently running from the, on the college website. We've had some sessions today and we're continuing it next week on Monday and Wednesday evening with some webinars which may be of interest to you. Looking at finance as doctors and looking at this topic that we're going into today. So, fellowships, um, how does this fit into redefining culture? So traditionally, some of you may have thought about fellowships, some of you may not have thought about fellowships depending on where you are in your training, but more and more as you progress, people ask you what you're gonna do where you're gonna go. Um traditionally, people maybe went abroad to Australia as a popular destination. Sounds like a great thing to do. Lots of you have lots of fun, make new friends, learn new skills, see a different healthcare setting, completely different to what you've trained in. Be able to take valuable things back for your job as a consultant. Um On uh paper, it sounds great, but sadly, probably the perfect candidate for this is, is a single surgeon or not even that necessarily these days. Um And so that might cause you to feel quite stressed today is reality, which tends to be. Most people have partners with careers, they can't leave their late thirties, which is when you tend to get to the stage of going on a fellowship. Lots of people have small Children who need daycare and education needs, which are hard enough to set up in your own country, let alone abroad. People have large mortgages to pay that they don't know how to cover if they have to go abroad or how they'd organize that for a year. Lots of people have elderly relatives that they're looking after. And obviously with all the current strikes and things, there's a lot of financial strain and going to Australia for a year or anywhere else abroad isn't without its expenses. Um So sadly, this is often the first time, maybe in lots of people's careers where they can't tick the box that sort of every, uh every other stage they've been able to do, um, to be what on paper is the sort of best candidate for a consultant job. Um, so we're looking briefly in this talk at sort of all other things you can do when to start thinking about it and what you can do to make yourself, um, just as appoint as somebody who has gone on a fellowship abroad. So when Maria and I were asked to have a, um to present this talk, we basically um realized that the traditional career trajectory in surgery is that you work diligently through your training, doing the same thing on the ward and the theaters day in day out. And perhaps towards the very end of this, you might then be expected to do this very unique and quite impactful experience abroad to suddenly become consultant material. And actually, we argue that um that is way too late to leave this and this year abroad might not quite live up to what you expect. So actually the when it comes to the crux of all of this, all of us here will eventually reach that table there where we are interviewed for a consultant position and we will be asked. So what can you provide this service? And how do you stand out from other candidates? So what is your unique selling point? And actually, it might work a lot better to think about this earlier on in your career. So what we're going to do now is we're going to speak to you about some alternative things that you can do to start working on your CV. And particularly because actually by introducing a lot of these factors, what you're doing is you're, you're working on things that are different to your day to day practice. Um And by introducing that variability that actually helps a lot with your well being and preparedness. Um So firstly, we're looking at briefly at PRE CCT fellowships and observers um both a broader at home. So I think there was, there used to be a bit more common possibility to think about PRE CCT fellowships and there's a bit of a belief that you can't do them. But if you find yourself an opportunity somewhere in the country, normally more in the UK do something that you, that complements what you want to do. Um Normally you can organize that still, even with the sort of more structured training program that exists. Um There's some fellowships that are advertised that you don't have to be at the end of your training. And actually, if you email or reply to the adverts, you might find that you can do them quite a lot earlier on in your training when it might be more, um it might be easier for you to do um sort of mimicking the longer fellowship observers which you can do abroad and at home. So these tend to be 1 to 6 week placements that you can do even in the UK or abroad, you can often get funding from them, either from the colleges or from sub specialty groups like the British Society of Surgery of the Hand. And if you apply, you often have to write a report afterwards explaining what you learnt. But these can work quite well. You spend a dedicated period of time, a smaller period of time abroad where you can see things in a different setting, you can learn new skills. You often aren't able to operate. You get to watch the operations and spend time at work with no other distractions from what you might have at home and no on call. Yeah. So the next thing we wanted to discuss is research. So um I've actually um taken a break out of my training to do an, an out of program research for a phd. And I understand that a lot of people that, that probably doesn't appeal to everyone in this room. So I think um what can be quite interesting about it is that you don't have to go to the traditional route. So for example, I know, I think a lot of junior doctors nowadays are quite interested in having what we would call a side hustle in health technology would start a business, for example. And actually, there are these fellowships that Mary had mentioned, including things like the NHS Clinical Entrepreneurship Program runs for about a year. There's also the health tech fellowship runs for about 12 weeks, which again would help to basically train you in setting up things like apps or simple online services so that you can use these in your repertoire for whatever other kind of ventures you've got, you've got plans for, with regards to what I'm doing just to go back to it a little bit. So I'm doing a phd in bioengineering. And the reason for that is, I think a lot of us have increasingly recognized that technology can help us to improve the way we detect and the way we manage disease, particularly in my case, I'm looking at improving oncological outcomes. And by doing a phd in moderation, I essentially getting trained in how to research and evaluate technologies for this purpose. So I'm really looking in this into this in a lot more depth. And although I've not really made up my mind yet, by the end of this, I would have the option of potentially starting up a portfolio that looks particularly at surgical innovation. So that is something that you could consider if that is what you would be interested in. So the third thing we also wanted to discuss was leadership evaluation. Oh, sorry, leadership opportunities. Um The reason for this is again going back to that consultant interview, which we'll eventually get to in your, in your career. Um They will ask you, have you done any work around this? So we all start off with doing small audit work. But actually the more senior you become, you need to start looking into doing more service evaluation projects. And if you can also service development projects, because then you show that you really can bring something to the table. Um There's more form, more routes that you can also take, which include things like the um R CSE D Clinical Leadership Fellowship, which runs for about a year, which again trains you in, in particular um leadership skills, which can be really valuable. So we hope that's been interesting. We've just had a quick 10 minute session, but we, as I said on Wednesday evening, have several newly appointed consultants and some trainees who are more junior who have recently taken some of these opportunities going to discuss and what they did. It's a free webinar if anyone wants to join it. And if not, we hope that gets people thinking a little bit earlier about what they might want to do and how you can do things a bit differently rather than feeling tied to the traditional typical surgical training pathway that isn't really that approachable for everyone at the moment. Thank you. Ok. Thank you so much for the excellent presentation. Any question from the floor. So we got one question. They will get you the mic. Sorry. Thanks man. Hi, great talk. Um What's the name of the webinar that you were organizing every Wednesday on the R CS Edinburgh College website? And there's a link to all the webinars that are running there. Thank you so much. Do we have any other questions? Thank you for, for a brilliant presentation. I have a question from um from my end. Uh Sorry, Michael. I did ask a question. Um When is the perfect time? Is everyone different in terms of getting involved uh starting your slightly different pathway? How do you make that decision as you go along? Question? I think it's a good question. I think it's difficult. I think so, sort of traditionally, I guess you start most specialties doing more sort of general surgery and subspecialist as you go further on and you may not know at the beginning of what you want to do. Um, which is why sometimes doing a fellowship at the end is quite useful because it, you've picked by that point what you want to do. I think now often with, if you have life outside of work as well as life inside work, you have to think about both and when is going to be a better time for you to do what you want to do for your career, which I think can mean that you need to do things earlier sometimes or do things differently, depending. I think it's never too early to try something as well, even if it ends up not being what you do, you still get quite a lot of skills from whatever you, whatever you do whenever you do it even if it ends up not being what you specialize in. So I think uh in most of the settings, it's uh the the leaders, the mentors that inspire you probably and encourage you to seek out those pathways and uh gain different experiences. Go go slightly, I think outside the box and uh explore. Yeah, brilliant. Thank you for the talk. Um And just to wrap up the session uh last but not least our own Michael will present our anti guidance from a Thank you. I need to be a little bit fast. So otherwise the or uh the conference organizer would kill me. So we are just going to present about uh the building discrimination and harassment guidance. This is a survey that we um tried conducted among our council members. So first of all, surgical trainees, they have reasonable expectations um to feel safe and valid in the workplace. However, previous reports mentioned that poor behaviors and proving that poor behaviors that still exist as well as sexual misconduct. So we aim to identify if there is a need to assist the trainees to develop a standardized guidance, simple standardized guidance. That was the main aim of our survey, especially for those who have been experiencing any poor behavior or sexual misconduct as well as bullying or discrimination. So, first of all, our data among the executive council members of asset were collected and the questions were related to the trainees, demographics level of training, specialities, experience of witnessed or reported poor behaviors. We asked the participants um if they like the direction when they're experiencing poor behaviors and if supportive strategies were needed, we also surveyed them on different ways of escalation. So as a result from the demographics data, so we recently not recently within the last few months, but also in the last maybe couple of years, we updated our gender questions to make it more inclusive as maybe like one of the first training associations in the UK and Ireland. So we got questions, different ethnicity and different genders. We had about 5050 between males and females participants from the council level of training was very again inclusive from medical students to post CCT. We had 100% from the exact members and um there is about 95% from council members general surgery as usual, very popular specialty. 50 per cent, we had also other specialities from trauma urology, vascular plastics, cardiothoracic questions about bullying. So we asked them if they experience any bullying behavior, 55% experience bullying among the council members and if they witnessed any anybody behaviors, there was 77%. And the question about reporting as usual, have they reported any billing? There was 67% they did not report any billing behavior discriminations. 37% today experience discrimination behavior and those who witnessed 62% about 70% did not report any discrimination behavior when it comes to sexual harassment. So 24% they experience sexual harassment on the council and those who witnessed were 29% and those were reported or sorry did not report were 72. Over 80% mentioned that they need more guidance to support the trainees. And almost all participants, they agree that surgical trainees, they should be made aware of different routes of reporting. 88%. They agreed that asset as one of the biggest training associations should develop the guidance to support the trainees. And 80% they refused that the trainees, they should start by informally resolving the incidents with the offender. So there was one of the questions that had been asked by someone from the GMC. I think it's usually a misunderstanding. So why don't we ask the trainees to speak informally with the center? So 80% refused. So this is our simple guidance that was developed. So again, one of the comments that we received recently, so this is not new. So everyone knows about this kind of routes of escalation, the problem, we assume most of the time that everyone knows. But if someone is experiencing poor behavior, as we even surveyed our council members, those who are representing trainees in the UK and Ireland. So most of them, they were not aware of different routes of reporting. So first of all, we suggested that they will try to solve the problem or report at the local level. So they can speak with educational or clinical supervisors, speak up guardian, as usual clinical or medical directors, it hasn't been resolved so they can go and escalate to the TPD to head of School of surgery. Again, maybe for the trainees, they can be more aware of different routes of reporting. However, if they are not in a structured training program, so we suggested that they can go directly to step three, which is the GMC Confidential Helpline. So they can anyone can report to the GMC. But there is a confidential helpline. We suggested that the EDI officer can be involved or um they can let the EDI officer know as being maybe a third party that can help support them, guide them um or even they can keep the course of incidents for future formal reporting. So we've been trying to maybe increase the awareness of um the trainees in the last couple of years. We've done a few publications um at the Built in at the Annals of the R CS England. One of them is about the elephant in the operating room, calling out building a discrimination surgery. And also we published this study about survey among our council members and our guidance. We also recently published at the Built In the reflection from different surgical leaders on the idea of reporting in general. How can we report any poor behavior and also reflection on our asset guidance, some case reports, um consents were taken by the way, and everything is anonymous. The first one im doctor underrepresented groups, as usual, they fell discriminated bull on kind of a daily basis. As they mentioned, behavior was witnessed from other colleagues. They spoke, they decided to speak up. At first, they spoke with the leads consultant and they received even worse experience of Bill from the lead of the department. They mentioned, they complained then in writing, I don't think everyone would go through the process uh again. So they mentioned they, they decided to complain in writing and they were kind of forced or obliged like to close the complain informally. Another one, there was a train this time experience, poor behavior, aggressive shouting threatens um in theaters. And um it seems from, it seems like it was from um a consultant from different speciality. So probably no direct authority incident was witnessed again. Um So they decided to put it in writing again. I'm just just giving you some examples of those who decided to report not for those who didn't report, they reported um to um clinical director and they put the DEX in and they referred to our Asset Guidance which is recently published in order to let them know that they are aware of different ways of escalations including the GMC. So they mentioned as results took them only two days to reply back, even at the weekend to mention. Then yes, we are aware of your complaint. We are doing investigations, we haven't been told yet. Um, so I'm aware that the investigations was done, but I don't think that they got uh, reasonable or satisfactory outcomes yet. Hopefully they will. So future plans. Um, so we got one feedback from an Irish trainee mentioning or referring to our guidance that we got the GMC helpline or confidential helpline. So they said we don't have anything about, um, the Irish Medical Council looked online, we tried to contact them. So we found that this is an email address that they got. I even tried to email them myself and guess what? They never applied. So we've been trying to contact the Irish Medical Council and hopefully, um we can work together on whether we're having a confidential helpline or we see how often they check their emails or how often did they get a complaint. So we've been trying to work with different training associations on um developing standardized ed workshops as with B we are trying to ensure that our policies are up to date. We updated our policy, it's online on a website. So I think anyone can go through the online website, check our a policy and I'm happy to be contacted if you have any suggestions. We just are trying to ensure that all the trainees, they are aware of different routes of reporting and um maybe what you can do, try to print it, post it, um email it to all your colleagues and hopefully we should be in the future. Thanks everyone very much. Uh Are there any questions? Um Oh, yes, let's start with you. Right. Um Having worked in this sort of sexual misconduct space and also having been through some sort of bullying experiences myself, do you think that people who report these incidents have the right to find out whether or when action has been taken? It's a good question, I think definitely they have the right. This is from my point of view. So as a trainee, which is I think as well as you mentioned. So I think I experience as well poor behaviors. And when I reported, I needed to know what is the outcome. It's the same thing when I took the role as a officer and I've been trying to support some of my trainees um in my department or even as a adi officer and trying to, you know, give some advice generally to our asset members. I think it's very important to get back to them and tell them, look, this is the ways of escalation. If you spoke with your education or clinical supervisor, they haven't taken action, then this is what you can do. This is how you can escalate. It has a lot of impact on their well being, I believe. Thank you. Ask. Actually, two questions. 1 may be a little bit more of a comment. I'm a clinical teaching fellow and I teach final year medical students and I recently gave a talk about bullying, harassment and instability at work. And to my surprise when I ask a question, whether they even know a term of instability, they were very unaware of that and they have not had any previous training in even recognizing harassment or bullying and whether that change needs to happen on a university level. So people entering the workforce are already educated in tackling that early. Um I do not know if you see any ways going forward to change the medical students portfolio to include that. The other thing is that as, as much as I appreciate all the reporting and it is crucial to tackle the problem. Also, it puts the burden on the people who are experiencing or witnessing harassment and whether we also need to approach people to understand very early on which behaviors are acceptable or not acceptable in terms of, for example, induction in the trust um to uh also tackle the people who are potentially going to um behave inappropriately. So to prevent that from happening in the first place, there are few questions aren't there. So I think regarding the first question, um it would be very useful to have even like EDI um workshops, even for undergraduates. But we start with the post graduate at first, maybe we can do it in parallel. But I think it's very important um to start shaping the future and trying to understand that even, you know, junior doctors, most of them, they are not aware of the EDI policies. They're not aware if any policy would exist in their trust. Most of the trust they say yes, they have ed policies. But you know, when we try to refer to them, it's very difficult to get a standardized one. Your other question was about sorry. This is, again, um every trust would say that they have policies and that's why we tried to make our standardized guidance so we can refer to it. Um So sorry. Yeah, go for it. Did it answer your question or not? Brilliant? Hi. Uh Hi Roly. So uh we've got a National Institute of Health Research grant that is looking at AD I smart dashes and we're developing it into a bigger grant. We would really love to work with you because we see you as a key group that are targeted for this and therefore we need to add your voice around it. So I'm gonna mail you. Um but we're really, we're working with different trusts that are already referred. And from that, we're really getting very different results around what even the trusts understand ed and different interventions. So I will mail you but it would be lovely to work to work with you because your voice is really important because you are much more likely to be targeted in this way and therefore hearing and including your voice is a a key way forward. Thank you. So much. I'll be waiting for your email. Do we have more time or? That's it one more question. Last one. Thank you very much. Um Thank you for doing this and for the recommendations for what people should do when they encounter these scenarios. But what I'd be interested in is and I can open this to the board is what are your recommendations are the consequences for those people who do those behaviors? Because I would happily bet my mortgage on right now. Everyone in this room knows a practicing person in a position of power who is a bully and has been in that position for a period of time and everybody who works with them is aware of that behavior and nothing has changed. And I feel that people, one of the reasons and I'm sure there's many and I, I'm not an expert in this area, but one of the reasons people feel they don't want to report things is that they don't feel that there are consequences to those actions or things will not change. So what other, what would you feel as, as recommendations as the consequence of those actions? Because those people still have trainees, they're still put in, you know, situations where they can enact their behavior. Some of them, they are still supervisors as well. Yeah. So I think one of the uh I think following Australia's guidance of the sort of meetings with and without coffee escalation protocol is a good idea. Um So if you've not heard of that, it's first you have a meeting with coffee. Oh, by the way, this, I've noticed this thing is happening, can maybe cut it out. Then a meeting without coffee is high. Um Can you come to my office? I have a thing to talk to you about again and then it becomes more formal and then there are more people in the room and then there are official sanctions. Um I find that particularly interesting having I bumped into somebody recently who was actually sort of had been a director of medical education where I'd worked and um where I had been through a bullying um uh reporting situation and, and she was now, everybody in this scenario was now retired. And uh and she said, oh God, I had such a problem. I brought them in week after week for a meeting without coffee and said, come on now, stop bullying your colleagues. And then a few months later we go back again, stop bullying your colleagues mate. So I think I would it without that knowledge, I would vote for um casual interventions, informal interventions amongst um professionals. But I think actually knowing that and kind of putting my feet in her shoes, um maybe sanctions are the right thing and having to do things like go on things like courses that might be seen as being um embarrassing to have to go to and things like that. Just to curb behavior. I don't know what you guys think. I totally agree. Becky. One of the things that most of the time and you trust, if you try to escalate to a local level, most of the time, the trust will try to bury, just to try to hide what you've been trying to say. No one would like to have what they call a headache. No one would like to have problems. No one from the managerial side would like to have or to go through the process of investigations plus reputation of the department. This is very important. So when we speak about reporting poor behavior to a local level or even a national level include maybe, you know, or get the NHS or health education England involved. No one would like this to be escalated to this level. So greater we have to remember that this is an employment issue. Um And actually the trusts have got policies in place for this. They need to follow those policies. They need to enact the employment law that is there. That means that these codes have been broken. These behaviors are unacceptable. They have to go through the C and the non copies and then the chats with hr and people have to be given a chance to change because they may just not be aware of it. But yes, ultimately, if people are not going to change their behavior, you need to have the leadership in place to sanction these people, which means firing them, which means not being employed by that trust anymore. If they're not going to change their behavior and we need to reframe that discussion of, oh, it's a headache for the trust to go through this process. It's more of a headache if you've got trainees that are being abused and bullied, if those stories get out the, the, the way to the, the phrasing of it is what happens if we don't do anything about this, you know, what is the repercussions for our patients? Because no doubt if they're bullying the trainees, they'll be being rude to the patients or they'll be, you know, the next Ian Patterson. Um and those are the things that you need to use to be able to negotiate and get the change that you need at that organizational level and to actually know and, and the people at NHS England are, are, are adamant on this. There are, there are systems in place for it. Just trust needs to be enacting it. Um And actually it's quite a good stick to be able to say you've got a policy, you haven't followed it. Um, why haven't you followed it? Um And again, getting sure that you've got the unions on board, uh the experience of the London Ambulance Service, um, for all the people that they have fired because of their inappropriate behavior or their criminal behavior. Should we say those that are taking them, taking the trust inverted commas to employment tribunals, none of them are being backed by their unions because the unions are happy with the way that the trust enacted and followed policy and procedure. So they're having to foot the bills themselves, which again is just a really good example of how these things can be managed. So just going back to the idea of approaching this informally and this is with regards to kind of people trying andress set boundaries, whether it be inappropriate, inappropriate banter or essentially harassing you to a point where you feel undermined et cetera, you can push back a little bit. So you are allowed to work in your workplace and to feel safe and comfortable. And if you feel that someone is transgressing those boundaries, you can set those boundaries straight by all means there's a tact and a way to do it and but you can essentially do so. And I think you do start doing that a lot more, you realize your rights a lot more, the more you become senior. And that's why you get a lot of these consultants or very senior perpetrators, really just targeting quite junior doctors and you can speak up is what I'm trying to say and no, it won't impact your career. Maybe whistleblowing does not going to deny that. But actually just firmly saying no, I'm not comfortable with that. Actually, they will know that you're not someone who would be willing to accept this kind of ongoing behavior. So that's something else I recommend. Thank you very much. I think it was a really nice way to kind of wrap up the session. It's important to foster environments where everyone is allowed to speak up and they've got a safe space to do so. And also having the pathways that we're aware of empowers us and knowing that we can make a change by speaking up having these hard discussions is, is really empowering. So we'll lead on to the next session. Thank you for the lovely speakers.