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Hello and welcome to another pre recording from the Black about Academy of Surgical Skills. My name is David Ragan. I'm a cardiac surgeon in Yorkshire in the United Kingdom and the immediate past director of the Faculty of Surgical Trainers for the Royal College Assessment of Edinburgh and a visiting professor at Imperial College, London. I have the privilege and pleasure of introducing a friend and colleague is also a regional surgical advisor of the Royal College of Surgeons of Edinburgh. Mr. John Taylor. He is a consultant. Trauma, an orthopedic surgeon based at the Mosey Regional Major trauma Center at the University of Entry Hospital in Liverpool. During his training, was apprised research fellow within the University of Luisi. Will Department of Surgery in a US A. Working under harem Polk. After completing general and vascular surgical training, Liverpool was appointed consulted general vascular surgeon in the southwest of England. And then we turned in 2014 to the regional Trauma center in moseying side. As a consultant, trauma and emergency general surgeon, he's the lead for acute surgery in the Liverpool School of Medicine, a regional surgical advisor for Law College of Surgeons of Edinburgh, and is one of the national course directors for specialty skills Emergency Surgery in Trauma, organized by the Royal College of Surgeons of England. I was delighted to find that John shares a similar pash in in martial arts, but he's a lot more advanced than me. He has 1/5 Dan Black Belt and show to Karen Karate and has won several national championship title's, including at British University Team Gold in 1987 as well as the British Karate Association Carter in 2001. He is also a British show to Count Kijiji, kumite champion in 2005, and in addition to karate, he also studies weapons and you'll note in the background he has a sword. This is at work. I'm told. It's a blood blade and he holds the first down in this discipline. But he's learning all the traditional weapons. John, thank you very much indeed for joining this evening, I look forward to joining you next week in Liverpool at another dose. CEO of the Black Belt Academy of Surgical Skills. I wanted to ask you, in your experience as a trauma surgeon and experienced surgeon House karate, helping you And how is it helping your training? And where do you see the similarities? I think a lot of it is down to the kind of the practical aspect of what we do. You know, it's it's not just you're not just learning about the surgical disease you're actually, it's the physical, you know, aspect of operating, which is a large part of what we do. Our surgeons, you know, any or any interventional specialty. It's not just surgery these days. You've got me in the gas. The gastroenterologists do stuff for cardiac. The cardiologists do stuff, you know. There's lots of the specialties, are interventional and need some sort of hand skills. And I think the similarities for me is the kind of the gradual development of those skills in that we can't you know, not every you know, F two or F three or, you know, first Year Corps trainee has a fully as fully developed hand skills. You know, sometimes you know you're watching trainees operate, and it's, you know, you're kind of thinking you need to you know, you need to practice more and you know and again it's an aspect of modern training that we, You know, the volumes that me and you did as a trainee, where we we kind of learned on the job a little bit. Well, yeah, we learned on the job full stop log. It was volume not actually being taught. But then you you know, and so it's kind of that that mirroring of, you know, the development of hand skills from very basic things, you know, you know, something as fundamental as how do you pick up a needle in the needle holder And just those little skills, you know, to like karate, which is how can you make a fist? You know, you know, you see beginners, you know who make a fist in. You know, uh, actually dangerous ways, you know, And they took the films on the inside. You know, if you hit something hard, you're gonna break your you're gonna break your thumb. So it's it's kind of teaching, you know, they're working up from the the basic skills and just allowing them people to develop. Um, you know, in you know, those basics into more advanced combinations that again, a lot of it's how you know the how were training and I don't think whether it is a as a profession. I don't think we're very good at it. You know that? That's the things. You know. Obviously, we're trying to improve skills trading primarily because we don't have the volumes as we used to. You know, we were not operating on, you know, 60 open appendixes before you get your registrar post like I did now it's, you know, it's a lot smaller numbers. It's more focused, and we should be teaching our trainees, you know, on various various exercises so that when they actually need them, they all those skills are there. You talked about how to pick up needles and how to make a fist. That seems very basic. You'd be surprised. Uh, you know, You see, I mean, I mean, you're talking fists. I'd see that. Okay. Just because if you hit something there, you're going to break your thumb, which if you catch your thumb on that, that's gonna break. So, you know, just to teach a beginner that takes, you know, that's that's the first thing I teach have to just to make sure they're not going to do something dangerous. And, you know, you know yourself when we're looking at, you know, trainees picking up a needle. Then it's, you know, it's either, you know, too far around. Too far back too far. Back in the needle. Hold it. It's a little It's the little things that make the difference. You know how, angling it out a little bit. Just that something as fundamental is picking up a needle Or, you know, the other thing is, you know how to hold forceps. You know, again, something else. We teach and show people. But then you see a huge variation how people do it. And, you know, we go through the reasons why not to do it. It's so it's It's the little things often, um, that make that make the big difference and make life easier. I'm not obviously safer. And obviously, that extends in your karate. Your karate training to get to fifth down. What did you have to do? Uh, well, I started in a little club in Whitley Bay where near where I grew up. When I was I think I was about 15. Trained for a few years with, uh with 11 instructor, then went to university. Uh, then again, It was just regular training. You know, it's very much a lot of it's just basic. It's just line work, you know, you're you're doing prearranged moves. So you're getting tooled. What to do? It's about form how you do it, how you twist your hips, how you move your feet. Um, so you know, you don't Actually, no, I didn't have a fight, you know, until probably I was eight or 10 months in. You know, when I when I first started, you didn't You didn't go one on one to get, you know, you know, at least for you at least six months unless it was pre arranged or it was very, very regimented and scripted. So freestyle, you know, free fighting for, you know, in beginners We don't do because it's dangerous. You've got to learn the basics first, you know, and then you work your way up. It's a series, a series of stepwise exercises. So to get where I did it Basically a lot of that. A lot of prayer age. You know, we learned how to learn how to move, you know where to move, uh, series of techniques. Things like timing, distance being able to judge distance. Um, and then, you know, and then traditional martial arts. You know, there's a lot of different lots of different things and lots of different ways of doing things. But the traditional Japanese or canal and stuff that we both do. Um, you know, there's there's three aspects of that. There's Keyon, which is the basic practice. Cataract, which is form which is formal exercise and prearranged, you know, sequences of moves. And then there's committee, which is fighting which can be pre arranged and then up to freestyle. So basically, you just kind of go up an increasingly complex series of exercises in various things and, you know, and then time as well. You know, there's a lot you know. Traditionally, you go from you get your first down black belt, which in Japanese terms is, you know, an experience. Beginner to a black belt is not the end. If anything, it's the beginning, you know, and then you just work up, you know, two years to take your second dance. Three years. Take your third four years to take your fourth like that. Although that's a very that's a western kind of framework, you know, but but a lot of it is. You know, you kind of advanced when you're ready through these exercises. Um, so it's not just, you know, get on the mat and have a scrap. You know, it's it's very much it's very regimented. So building in complexity over the years and lots of reputation. Uh, and you don't do that all in the dojo, do you? You don't do that all the time in the dojo. You practice at home? Yes. Yeah. I mean, you know, you know, I've got space. I'm lucky that I've got space in the back garden. You know, if I've got spare, I think Well, what am I What am I doing this week? What am I working on this week? And you know, like cattle, which is the forms, you know, some of the stuff the advanced level stuff is, you know, is of they're very long and even in like, especially the weapon cata that I'm studying at the moment. You know, the weapons cater's are twice as long as the longest karate cata than I know. So again, these are complex series of maneuvers which all put together have meaning which but what each individual bit can be taken away and used in a practical sense again, very much like what we do. You know, I keep telling trainees that certainly in vascular surgery, you don't learn an operation you might learn, you know, a particular sequence of things to do for an operation. But what you're basically doing is learning a series of techniques because it's like, really that old that you know, that old quote from I think it's 1/19 century, century German general, you know, paraphrasing it is, you know, no battle plan survives five minutes contact with the enemy. You know, you you start an operation, you move from planning to plan B. You know, well, something goes wrong and you've got to then move to a different technique. You've got to then move to plan C D E A f. And eventually, you know, it's only when you get to X, y and Z that you've got to start worrying, you know? So it's it's very much like that you're learning a series of techniques rather than a specific operation. Or, you know, uh, and that's particularly true as a trauma surgeon, not knowing what you're dealing with when you go in. So you do need to be well equipped and well versed and techniques, procedures and your surgical weapons, so to speak, to deal with trauma, which doesn't recognize anatomical boundaries. Yeah. I mean, I'm lucky. And I was, you know, I'm an old school vascular and general and vascular training. I kind of came through just before vascular started to split off as a separate specialty, although it was very well developed at the time. Um, so, you know, I've got a kind of well developed generals, you know, skill set and a fairly general open vascular skill set. You know, I I kind of just kind of on the cusp of the end of vascular revolution, which I kind of kind of passed me by, um, to a large part. Um, so those skills, you know, again, I take from, you know, I I you know, I take into my current practice. So, you know, I deal a lot of with the vascular trauma, particularly. So it turns up on my watch. Then I'm more than happy to deal with it, so, you know, you know, sort of what sort of peripheral artery arterial reconstructions. Things like that for penetrating trauma, you see, not commonly, thankfully. But we see often enough to, you know, have I have got reasonable experience of that. But also it's the visceral stuff as well. You know, the general, you know, taking bits of bowel out and, you know, doing all that. But also, it's not so much the practical side as well. It's the decision making. Sometimes it's sometimes a decision not to operate, which is the kind of the next level. It's all very well. Yeah, you can do that, do that. But then it's the decision not to operate sometimes or a lot of the time actually in trauma And, you know, or you're going to sit and watch and wait and, you know, it's sometimes that can be quite a brave decision. Has your martial arts helped you with that thinking? Um, I think so, because again it's a lot of it is. And I think some people do struggle with emergency and trauma because you've got to make a decision. Now. You know something happens. That's it. You have to make that decision standby it right or wrong, you know, and we don't We don't get it right all the time, you know. But also, it's the kind of, um I think decisiveness. It will be a thing where, you know, again, if you're on the mat and you you are fighting, it's like, you know, it's kind of you've got to pick your moment, and then you've got to do something. You know, if you here, you know, you're two points behind the competition. You hear the 30 seconds or the referee shouts 30 seconds you've got to do. You can't hold back. You've got to just make a decision to go with it. You might they might score another point on you. You know, you might you might get, you know, you might land to kick in your head. You're coming in attacking to me before, you know, I've got, you know, I've got beaten, you know, I've been going introduce, you know, attacking. And then the other fighter is just went buff. That's it. And it's like, Okay, that's it. You win a few days. So it's that I think it's a decisive sort of that kind of decisive sickness, and you know, that sort of ability to say right. We're going to do something now. I'm not going to think about it. I'm not going to wait for a scan. We need to We need to just do this now against kind of. I think that's kind of helped. Quite the best. How do you see? We should be training today. We know that the volume is down, and, uh, we don't have many wet labs. How do you see? We should be training surgeons today. And what do you think are the parallels with karate learning again? I think it's that phase. I think we should be encouraging our trainees to practice. Okay, Because again, you know, we've If you look at how we are teaching the vast majority of surgical skills teaching at the moment, it's very it's very hit And, miss, you know, you've got to pass the basic surgical skills course, which both of us have an opinion on, you know, But, you know, I still teach on it. You know it. I'm not going to see it here, but I think it's we were teaching the wrong things. We're you know, we're not teaching how to pick the needle up, how to hold a pair of forceps unless we're doing something like this, you know? So the vast majority of our trainees, you know, aren't getting that exposure. And I think we should we should We should have possibly a fundamental reset in the curriculum of what we're teaching on June or more. Junior trainees in particular, is, you know, teach them the very much basics. Again, it's going back to, you know, this back to sort of an Eastern concepts issue. Hari idea, you know, which comes from Japanese tea ceremonies. Not martial arts, but it's the, you know, the shoe is the teaching of the basic principles. You know, we don't do that very often. You know, we don't teach our basics, you know. You know, we do it in the karate lesson. How to make a fist how to how to step forward. You know, you pull your foot in and drive it out, you know, rather than step straight through, you know, teaching somebody how to walk again in a karate lesson, you know, generating the power from that, you know? So we're not We're not teaching. Our surgical training is the very, very basic stuff, you know, And using, you know, picking the needle, how to use the curve of the needle. And you know which which we're trying to do here. But should be looking at that in the wider school. Indeed, I'm sure our listeners be interested in the walking analogy in the sweeping or the foot forward. Why do we do that? Well, if you again, you pull. It is your If you just step forward in stance, you know, there's there's very little power. You just don't generate the power off that If you pull your foot in and use your supporting leg to drive, then drive forward. You get a lot more speed and a lot more power. Um, you know, And so in a you know, in a good karate school that's going to teach you that, then you know that's basically telling you to walk differently. And kids looked really quickly. Uh, adults, you know, it's teaching adults karate. You know, beginners is actually quite difficult because they're so ingrained in their old in the habit. So, yeah, we can all walk, but you can't walk. How I want you to walk sort of thing. You indicated. Like to that you started at the age of 15. It's a number of years to get to 5th. 5th down? Yeah. I mean, it's starting at an early age and starting to walk properly. Let's put you in good stead now. Yeah, and you know, it's we have kids in our club we've got We take people from kids from four. It's like herding cats. But, I mean, we've, you know, we've you know, over the years we've got several students that kept it on up to third down. Um, so, uh, the kids at the start early, You know then that if you hold their attention and sometimes it's difficult. But if you if you if you if you hold them, you and you teach them the basics Um, you know, they're awesome. Absolutely awesome. And we've got there's a little girl in our school at the moment. Who is if she sticks with it. She's been with us about 18 months already, but if she keeps on, she'll be absolute awesome because she's really easy to teach. She's focused. She practices at home, Her techniques flawless. Um, you know, and I think it just shows you a little what? What a little bit of focus on learning the basics can do in karate. We both know that each movement is determined by a particular posture or stance. What are your comments about posture in surgery and at the table? Uh, well, it's well, we both know about surgeons with neck problems, don't we, Uh I think it's one of our common things we have between the two of us, you know, you know, and I know I know so many surgeons with problems with the back and the neck and again, you know, I tried. You know, I I try my best, but it's sometimes not good enough. And, you know, I think and again learning to stand up straight and not stoop over the table. You know, something as simple as that, you know, And you don't if somebody's doing it, Nobody pulls people up saying, You know, don't be stupid, you know, stand up straight. It's just the table to, you know, just the table to the highest person, you know. And if it means the operating surgeon has to stand on a box, let them stand on the box, you know? You know, I remember. Remember consultants that I trained with many years ago, it was only was 5 ft nothing. Yet the table is always at his height, whether he was assisting or operating. So everybody who's taller, which was basically everybody, always was either had to sit down or, you know, and if we couldn't get a chair, this stoop. So again, posture is very important because again, we were potentially. You know, we've got a long career to look forward to, you know, these days and you don't want to be going off at 50 with the shattered neck, which is, unfortunately, quite a common thing. Yes, indeed, indeed. And we have both commented on basic surgical skills being taught, sitting down in a chair. Yeah, I mean, I think it's such a I mean, when I first saw what you were doing with the ironing board again in common with a lot of what you're trying to teach, it's just I just looked at it and thought, This is such a simple idea. Why didn't I think of it? It's because we don't operate sitting at a table, you know, we don't operate stooped over, you know? You know why? Why are we teaching trying to teach skills in a position that is completely alien to what we're actually going to do at the end point. You know, we should be teaching people the correct posture, doing things at the right distance, you know? And, you know, if nothing else, to keep them healthy. Indeed, indeed, Just as a final comment, I'm going to draw on the prop that you've got in the background. Could you show us a posture with your sword and tell you why you're holding that and compare it to how we hold a scalpel? And why we do something with a scalpel? Are you able to do that? So? So just in case anybody's wondering this is not a live played. Okay, this is I told a practice sword. So again. So if you look, uh, in which hand I'm holding this in. Okay, so for a start, I'm holding it with my left hand. Okay? The sword is always carried on the left, right? That's just a Japanese thing, because again, you're going to draw it with your right hand. Okay? Because again, most people are right handed and the Japanese have a little bit of thing against left handers. Okay. So again, it's something as simple. I'm not going to the full ca my posture's but something simple as how you hold the sword. Right? And this goes for how you hold a ball so you do not hold it rigid. Okay, that's that's, you know, that's stiff. So it's kind of nice and relaxed. Very difficult to get two hands on the camera here, But again, it's kind of nice. Relaxed grip. Okay, so you are not right up on the hilt on the super. Just get nice and relaxed. And so you're not just it's not a shopping weapon. It's a drawing slicing weapon. Okay, so it's It's like I said about the hands. Okay? How you hold your hands of various important using the sword. Okay, Stay with a bow. Long stuff. Okay. Just to show you assume this is just a stick. You know, again, people who say people holding stuff's very rigid, whereas you pull your forearm around it and closes down the gap between the stick and the forearm. So you you know, nobody's trying to take it off you. So again, how you hold things. So again, I don't have a scalpel to hand, You know, Don't hold your scalpel like that, you know. Find work. Pencil. Okay. Going through tissue pressure. Use the curve of the blade. So again, it's something as simple as how you hold things. You know, again, we don't really teach it very well in surgery. Yet in martial arts, it's fundamental to what we do. Exactly. Exactly. And that's why I'm delighted, John. Do on Borders. A sensei with the black part academy. We share the same philosophy, and I think we can help with the development of basic skills for the future. I'm extremely grateful to you for joining me this evening. You've had a busy day in clinic. Thank you very much indeed. Wish you well and look forward to seeing you shortly. Okay. Thank you. It's nice to be here. Thank you very much. John.