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Good evening everyone. And thank you for joining us tonight on our first webinar actually for this year. Uh We are very pleased for you joining us tonight. And uh I hope that you have used middle before. But if you haven't, we have, uh we have uh been very keen actually to move into middle as one of the uh open fri uh platform for medical professionals, open for, for twenties in the UK and also open for, for surgical trainees and, and medical practitioner in general all over the world. Um I'm very pleased that we're going to be talking today about parents in surgery. And I'll ask Lilian who's uh our use club Vice present to, to start by introducing our speaker. Hi, everyone. Good evening. Thank you so much for joining and thank you Mo for introducing me. So this is our first webinar in a series of webinars that we're hoping to have the next couple of months. We're hoping to look at the challenges that are faced by surgical trainees and we hope to start a conversation that involves solutions to mitigate difficult circumstances that you might face. So on the panel, we'll have Victoria Pechman as well, who is one of our dudes club representatives. Um But uh first off, I just wanted to give you a little bit of housekeeping for today. We will have three talks from really some esteemed speakers. And um I'd like you to put any questions that you have in the chat function. We aim to finish at around eight pm. Uh Please please uh make sure that you enter your questions and you stay till the end to hear the answers will present the questions at that point to our speakers. So now on to a first talk, it is my absolute great pleasure and honor to introduce Professor Fiona Mint. She is a consultant vascular surgeon by profession. She's the vice president of the Royal College of Surgeons and she was lead for the parents in surgery report. So hopefully we can have Professor Mint on the screen. There you go. Thank you very much. Okay. I'm just going to share my slides. Okay. Well, thank you very much. I'm going to go back again. I hope you can hear me. Um Please say no if you can't hear me. Good question. So thank you. So, parents and surgery. So parents and surgery was a project that came about as a result of the Kennedy report that was commissioned by the Royal College of Surgeons almost two years ago now. And this was an independent review on diversity and inclusion um that was conducted by Baroness Helena Kennedy, and she gave us a 16 point recommendation report. And 0.8 of those recommendations was really to put together a team to look at the problems that surgeons particularly trainees. But all surgeons have with being parents and being surgeons and that this task force should put together in the first instance, do um an information seeking project, put that together. And that's what our report that came out. This one parents in surgery. This is the first part of our project. And what we did was we spoke to a lot of surgeons members, fellows, our staff and we look to find out what the issues were now. Of course, I think we all knew there were issues. I mean, I'm apparent myself, I knew there were issues and I think most people did. No, but I have to say I was quite surprised when we did the report at how bad the issues really are. So, having spoken to a number of our members and fellows, we came up with a vision and this is that all surgeons and dentists because of the Royal College of Surgeons England, we have a dental faculty as well. Should have the same access to opportunities to employment, to training career prospects, whether or not they have caring responsibilities, predominantly parenting, but other caring responsibilities as well. And having spoken to a number of people. And when we put together our report, these are the number of findings that we we made. First of, first of all, of course, parenting is a very sensitive issue. It's joyous for many those people who willingly become parents and have Children, it's a wonderful time. But for some people, it's also heartbreaking. They spend time having fertility treatment. Some are successful and become joyous, some are unsuccessful and become heartbroken. And there are some people who are never able to have Children and they carry on as surgeons as well. So we understand that it's a sensitive issue. But for those that do plan a family and have a family, we also know that majority of people plan their families at the time when the mother of the parent of the two parents is most fertile, which tends to be when people are in training, whether you're in a training program or your trainings further locally employed doctor pathway. It tends to be at that age when you're finding it's the right time to have Children. But also you're on a training pathway and that can be quite difficult. And we also know from our research, a particular research that was performed in the United States that female surgeons have Children later in life, they have less Children than everybody else and they suffer greater infertility issues. Say they, I should say we are the female surgeon as well. And we also found having spoken to many people of parents, fathers, mothers, but surgeons would prefer to have some more flexibility in order to manage their childcare because it is difficult. We work awkward hours we can't clock off with in the middle of an operation. For instance, many of us are in to, to surgeon relationships which makes it even more difficult. We also found that maternity leave is actually better signposted and better managed in individual trust than shared parental leave. So we actually found that fathers trying to take parental leave had greater difficulty finding how to do it and actually achieving it sign posting is generally poor and most trusts don't have a sort of easy place to go to to what do I do if I'm going to become a parent and one parental leave, it's often talking to one person who talks for another person who talks to somebody else in hr who might eventually get back to you and actually in medicine in general, but particularly in surgery, there seems to be a great pressure to have to return to full time working after you've been away on parental leave, partly that may be perceived by the parent, but also perceived by the people that the parent works with. And sadly, we found that some people left surgery because they had issues with parenthood, either becoming parents are not becoming parents. And that's really sad for surgery because we all want lots of surgical colleagues. So as a result of the pins, parents in surgery document, um we felt that we would need to move forward with this. Um And we work with our women in surgery network as we know that the college has women in surgery network for female trainees and non trainees. And we also have an emerging leaders program which at the moment is particularly pushing women to take on leadership roles. So we work with those two networks to try and ensure that these leadership roles are available to people who have parenting and caring roles as well. We found a lot of best practice during our conversations and we want to share that and we also want to erase, raise the awareness of the difficulties of parents especially which is why I'm very pleased to be speaking on this platform. Today, we want to help signpost resources and that means going to trusts, going to hee going to other bodies to make sure that resources are there and are available and we're going to work with those stakeholders to develop a torque it for those who manage training. So with J C S T, with H, with H E is about to be subsumed by NHS England. So with NHS England, etcetera and part of the Kennedy report suggested that we work with an independent body also to corroborate our work and to support us. And we therefore commissioned the Nuffield Trust to do some further work, to further look at the extent of the problem that we have and identify the key challenges and see what policies there are out there and what policies could be changed and they produce this document called Future Proof. Um And I know that some of it was mentioned in the BMJ in the first week of March. And then I feel trust key findings with us. Um Nuffield trust, we're aware that we had many streams in the Kennedy projects and they felt that we needed to make clear links with some of our other work streams, for instance, with our differential attainment work stream. Because we're actually very aware that for, for female trainees, that there is a dropout rate between mrcs and F L C s for instance. And we think part of that is due to parenting. We also, they also found and corroborated with us that parental and caring opportunities had uh an effect on how people progress in their careers and the goals that people go for and ultimately achieve and found that female doctors coming back from parental leave took a little longer to progress, took, found it harder to progress. The male doctors coming back from parental leave and in the current climate where workforce retention is difficult at at every single part of the workforce, but at the top end and the bottom end and in the middle, it was saddening to find the 55% of the respondents in their survey felt that their parenting plans meant at at some point, they thought about giving up surgery entirely. And when they looked at the younger cohort, the medical students and the foundation trainees and the court trainees who hadn't quite taken on a hard training role too. In five respondents felt that their parenting plans, we're meant that they probably wouldn't pursue surgery at all and we're going to a different field. So mentoring a mentorship relationships for fancy importance and they found a worrying gap between the policies out there and what was happening in reality. So they made a number of recommendations which I think are very helpful. Firstly, that NHS employers should standardize the information available and the guidance available across the country that individual trust board should provide clear and inclusive, accessible information about parenting leave and about carers leave in general that hee or NHS England should continue to improve the support they have on return to workers as we know, h he has the support S U P P O R T T program for people returning to work from all kinds of things. But including parenthood, NHS Trust should also provide facilities for resting, breastfeeding and look expression and that they should consider appropriate childcare facilities. And by appropriate that we mean childcare facilities that are appropriate for the timing's that surgeons at work. So not childcare facilities that open after we've gone to work and close after we've left work, I've employed before we've left work. And they should also consider support for those experiencing baby loss or undergoing fertility treatment cause it's very difficult to sort of um some of the people we spoke to feel it's very difficult to sort of share with their colleagues that they are actually going off to have IVF because it's very personal and why should you need to tell your colleagues about that? So there needs to be some kind of pathway to support our colleagues go a lot doing this also that NHS trust again, this corroborates what we found should provide timely wrote us. It's not very helpful if you've got childcare issues. If someone provides you with a row to two weeks beforehand and you have to find childcare in two weeks, it's really difficult that actually applies also to rotating jobs. I mean, in core training, sometimes people rotate three months office. I beg your pardon at four months. And if you don't know where you're rotating to, then that can be a bit of a problem. And they also recommended that we at the Royal College of Surgeons of England should work with hee to identify case studies, which we have many of which are positive with flexible working practices with good flexible master NG um data and that we should share that. So from the College of Surgeons point of view, what next we will work with NHS England on these recommendations. We are in the process to developing supportive networks. We've already reached out to a number of people across the country so that we have access to different individuals, managers and teams that can help us disseminate this information. We're in the process of developing a talk it for clinical managers and we will help to signpost resources available. We are going to run a workshop if not more than one workshop as well for some of some of the people who were going to be working with. And we also looked internally when we first started the pins project rather embarrassingly, the college didn't have anywhere to change a nappy. We do now. Um, we'll be pleased to hear also that for those people who have maybe not been to a recent diploma diplomate ceremony at the college, you can now bring your Children and there is a room where you can park your buggies and everything. So we've become much more family friendly at the college. So thank you for listening to me. Understand we may be moving on to the next week. Er, thank you so much prof that was brilliant. Thank you for that fantastic talk. Um, please do not go away anywhere because we will have questions right at the end, uh, for all the speakers. Um, so next up, it is my absolute privilege to um, introduce our first trainee speaker tonight. Rajni Patel, I've worked with Roshni for many years during my phd and Roshni is an S T seven. Correct? All trainee in the London Devery. She's been part of developing, developing the parents surgery report and has been advocating for greater support for trainees needing fertility treatment, world training. It'll be really great to hear, you know, rushing. Thank you for having a slides open. We can see you, we can't hear you. Just meet yourself. Okay, lovely. Um um So thanks for the introduction million. Um So, um thanks also for highlighting the issues of um I think the struggle um for some people um to get to the parenthood point. So my talks entitled Can a career in surgery be fertility friendly? Um And I'll be just share ing some of my own experiences and that um the others have shared with me as well. So this was the BMJ um front cover that Miss Mint just mentioned, which covered um the Nuffield report um that was um from the parents and surgery that came out of parents and surgeries report. Um And it does acknowledge that that is that part of parenthood is, is sometimes challenging um for many people. Um I don't talk about adoption um in the context of this talk and I'm going to sort of restricted to my own experiences of infertility challenges, but I also want to challenge the perception of who actually needs um fertility treatment um to start with. So um sometimes we think um that it may be just a heterosexual couple that struggled to have a baby for a long time that go off to a fertility clinic um to undergo fertility treatments. But luckily, we live in a society where actually we can start our families in lots of different ways. So this, this is my friend Benedetta, she's a vascular surgeon and she decided to embark on solo parenting. Um And these are her twins um which um she managed to start her family um through having IVF treatment. Um This is another one of my fantastic colleagues who is in a same sex partnership um and marriage and they had their baby through um fertility treatment also. And this is my friend Emily, um she's a gynecologist. Um and she decided to actually um do egg preservation um during her training until she was able to get to a point um in her life where she is able to then think about um starting her family. So all these situations are very diverse and very different. Um But really my point here is just to highlight um that really anybody may need it. And actually in the UK, um there are 3.5 million people that have infertility, you don't have to be infertile to need fertility treatments. Um And I think it sort of works out about one in six couples needing to have treatment or one in seven individuals. So that's quite a lot. Um So what do we mean by fertility treatment? It's a very broad um topic and probably beyond the scope, obviously, of today's talks, I'll just talk about IVF, which is the treatment that I had and probably one of the most common treatments. So, so first of all, it's a logistical nightmare. It's also um an emotional and psychological nightmare as well. But I'll just talk about the logistics and what it means when you're in full time work as a surgeon. So, um during a normal menstrual cycle, um usually one egg is released. Um but the point of IVF is really to stimulate um the ovaries so that many eggs are produced. Um And the point of this is that lots of eggs can be then harvested once they're mature um to make multiple embryos and then the best one or two can then be transferred back. So, what that meant for me was that I needed to have um sometimes 10 to 14 days of hyper stimulation. So these are injections which encouraged the ovaries to make lots of um eggs and those um drugs need to be taken a very precise time point. Um And sometimes they need to be kept in a fridge as well. So when you're on call or you're working and you have a very busy day, it can sometimes be challenging when you're trying to sort of prioritize patient care. Um And then suddenly you find yourself not being able to take medications on time when they're meant to be taken. Um And some of the drugs really are precise because they're timed according to when um the fertility consultant will actually um harvest the eggs and it's on a really tight window of, of about sort of two hours. So they very, they really, really are strict with timing. Um, once you've taken your, um, stimulations for sort of 10 to 14 days, um, I then had to have a general anesthetic or sedation, um, to have the eggs harvested. So that's another day off work. And, and again, I think with all of these things, um, it's really important to stress that these timings are unpredictable when you're having the stimulation phase. I should also say, which is that first fortnight of treatment. Um often you have to have lots of scans and lots of blood tests which are unpredictable times as well. Some clinics have daily scans and blood tests on average. It might be about 5 to 6 scans and blood tests and, and so that again becomes challenging to sort of work out a schedule with okay who's going to cover your clinic, who's going to cover your list, who's going to do the ward round. Um So it really is for most people is that compatibility with, with carrying on with, with work, which which becomes a challenge once um the eggs have been harvested, um they are then culture or grow, they are left on a on a dish um and um mixed with spam for fertilization. Um and culture takes place for about 2 to 5 days. Um And this is a point where things can really be last minute. So um you could have a phone call about uh you know, early in the morning on day three and say actually, um you know, we need to transfer your embryo today. Um So you could find yourself doing a ward round consenting patient's and suddenly you have to um turn to people to, to find cover. Um so you can make yourself available um to go to your clinic for embryo transfer after the embryo transfer. Um There is a period of two weeks of waiting um before you do a pregnancy test. And that sounds easy. But actually, I think most patient's that have this find that the, the hardest thing. And certainly that was the case for me, it's the time of high anxiety and we all know nothing is, is black and white and medicine either. So once you have your pregnancy test, um that again involves a lot of monitoring um cereal beta HCG S to check that things are developing in the way um that they're meant to serial scans. Um And as you can imagine, these are private issues that you may not want to share with the whole world. Um what's going on at such a emotional time where things are changing and the outcomes are changing very quickly as well. Um And you're working during that time as well. So that, that becomes a challenge for many people. Um I read a very um I think frightening statistic where um it was done by fertility Network UK, where people that undergo fertility treatment. A third have felt like either leaving work or have left work. So clearly, we need to find a way to make work work and our work is surgery. So that's, you know, it's not a desk job, it's extra challenging. So we need to find really created ways of, of making this situation work because as MS Min, Professor Men also highlighted um there are some emerging studies suggesting that surgeons do need to turn to reproductive technology more than other people. So why should we worry about it? Well, as has already been highlighted, the child bearing age is happen as we're on our career trajectory and our training pathway. So during our late twenties and thirties, um so this is a time where we want to be making a really good impression. We want to be shining at work. You know, we don't want to be the person that needs to slope off two appointments at the last minute all the time. And I should add that with that previous chart that I showed you the cycle. It's not that you just have the cycle and you get pregnant and you have your baby. Um If you're under 35 your chance of having a successful cycle is less than 35%. And because the aim of the game is really to collect many embryos, um you have one IVF cycle will likely result in multiple embryo transfer. So you have to go through multiple cycles of having lots of scans working out the time when the embryo is returned. So it's not straightforward. And most, I think average patient's mainly 2 to 3 years of treatment before treatment ends. So it is an emotionally challenging time. It bleeds into every area of, of your life. Um It's a time when your friends, your family may all be having Children and it becomes quite difficult when things are difficult for that person that's going through fertility treatment. So in many ways, work becomes a sanctuary as well. Um And a place where you can really forget about all your other problems. So um this is one of the reasons why I think we do need to find a way to make work, work for people going through this. So um I should also add, it's also a massive financial train strain and that's why it's really particularly important to keep people in work because none of this treatment is really funded by the NHS in, in most cases. Um Even though it's nice approved, um it's very rare that people get the full cycles of treatment um that are recommended. So I wanted to know when I was going through this. Um Was I alone, was it something um that I was struggling with or did other people find it a challenge as well? So I did a very crude survey of trainees in my region where um I sent uh Surveymonkey style um survey out on our group, Dina really whatsapp group. And I sort of asked, you know, very simple questions. Um You know, had these issues affected, you, had fertility treatments affected you. Um How did it make you feel what was done well and what could be done better? Um And I had many responses um which in total represented a third of the women in our group. Um And this is what they said. Um feeling of impending doom, it was exhausting, expensive and relentless, frustrated. I didn't tell anyone. I felt hopeless. I did not feel strong enough to raise the issue. I am worried about the impact on our work on our fertility. Sorry, I'm worried about the impact of our work on our fertility and ability to have healthy pregnancies, stressed no time to figure things out. And this one was, I think one of the most disturbing ones. Um This person said there was no way I could even consider assisted conception due to the strain on my already exhausted mind and body and the perceived lack of support from work and intolerance of time off. I essentially resign myself to the fact that I couldn't have Children and was going to look into adoption. Um And I think that the overarching themes that were really coming through was that idea of being able to even access treatment. Um and not feeling strong enough to, to ask um and raise the fact that you may need to prioritize your own health. Um I was pleased to say that one person did have a positive experience and this is really good because it shows that it can be done and it can be done well. And this really came this person's case. Um There was a triad of things where they described having a very understanding, training, program director, understanding consultants, having understanding managers and kind colleagues. So it was this triad of all three that really lifted that burden of logistics and meant that this person could, could have their treatment well. Um And I should say that, you know, where I am, I'm really lucky that we've got a really excellent, outstanding and supportive TPD um who's brilliant with these issues. Um But they're not in control of all the factors. Um And that's why we need to raise people's awareness of the issues um at local level, at different individual trust and really have proper procedures in place. That mean that individuals have a good experience when they may need to go on this journey or if they do need to go on this journey. Um And I think disclosure is very important, I've had to uh have treatment over a number of years and I've been on both camps where I've not disclosed and eventually where I have disclosed my situation. And I think my own experience is that people want to help the default. I think of the human condition is really that people want to help you and they can't help you if they don't know what's going on. But I think the barrier to disclose and really is knowing that people will support you. So um we need to create this environment where people feel really comfortable and confident enough that when they do disclose that support will be there for them in a way that is what they need. So why does all of this matter and why is it important? Well, we really need to go back, I think to the fundamentals and think about what sort of a workforce do patient's want. What sort of a workforce do society want? Does society want? And what sort of a workforce do we want as well? Do we want to diverse for workforce? And um it's really to be congratulated that the report is very um inclusive. Um and we, but we do need to acknowledge that it is a woman in many circumstances that carries the burden of the fertility treatment um and also um childbearing as well. So, um and I think that is reflected in the latest statistics from 2022 from NHS digital, that show that 14.7% of consultant surgeons are female. So the way to really address these issues overall um is that we need to start thinking more pragmatically about recruitment and retention. Technically, the flexibility options are there. But there is this idea of perception and how it's perceived in surgery and we're responsible for changing the culture around that. My own opinion is also that the postgraduate curriculum um after we graduate from medical school, really needs to be revisited overall. Is it two prolonged? Is it, you know, does it, is it compatible to a woman that wants to train and surgery? Um and um other factors are also or will hopefully um support a positive change in this sphere. One is a fertility um treatment, employment bill that's being read as a private members bill in parliament. Um Sometimes they don't go through often, they don't. But I think it's doing enough to raise awareness around the employment issues for people that need um to have fertility treatment. Um Workplace policy is absolutely needed. Um So that individual trusts have consistency in how they respond to these issues. But really, we need to change the culture. I think ourselves and that's done by really educating and talking about these issues. They can be too buh but I think the more that we talk about it, the more it means that it's easier for people to, to raise issues when they have to go through it. So um that's it for me. Thanks very much and I'm happy to take questions if you need it if you if you have any. Sorry. Thank you so much, Roshni. That was an incredibly informative talk and, uh, and thank you for sharing such a deeply personal and difficult experience. Um, uh I completely agree with you the, it's very important to talk about these experiences. Um, and I'm very grateful to both you and Chris for joining us today. Um, at the end, we will be taking questions. So, uh, for the next speaker this evening, it is my great pleasure to introduce another in credible trainee. Chris Jones, who is our final speaker. He's an S T six correctable trainee in the East Midlands scenery. He's currently training less than full time and he had an intermediary transfer as well. So I'm really interested to hear his experiences of that. Thank you, Chris. Thank you very much, Lillian. Can you hear me? Yes, I can hear you perfectly see my slides, your slides as well. Yeah. Fantastic. Well, thank you so much for asking me to say to share my experiences. I've had a bit of a probably it's like chaotic past two years, um entering into parenthood and sort of navigating training through that. So really what what I'll do is just briefly explain my current situation, how I got there. Um And then hopefully discuss some things I think that might have made things easier and then I think it's sort of following on from this, hopefully have some discussions about the report and how this all ties in. So she said I am currently working 60% less than full time, attend to Wednesday, Thursday, Friday's my partner Rosey who's anesthetic trainee. Um It's also 60% less than full time. She does the first half of the week. And between us, we essentially tag team tag team parenting. Our son, Oliver is nearly three. Um, living in Nottingham, say myself commuting south to Lester and her commuting north up to Mansfield. It took us a little while to get to the point of being able to start a family. We did our, we met in med school 11 years ago, did our foundation jobs when you link to our foundation applications, which you could do then um and then wanted to embark on court surgical and court anesthetic training. Now, uh you can't, the timings of those applications are slightly different. So she had to accept her post before she knew where I was going to be. Um And unfortunately I got Bristol and she got Truro. So we had to do a couple of years since you have long term relationships quite common. I think a lot of medic medic couples, what it did mean that she applied to her TPD regularly saying that could I have an introductory transfer up towards the Bristol end? Basically, it took two years for that to be granted. By that point, I'd started, been successful, got an S T three job in the region. Unfortunately, my first S C three job was down in exeter. Um So we sort of leap frog each other for a year. But after that, we're finally back geographically in the same sort of area and started trying for a family. Um, so about a year and a half after trying, um, we had our son Oliver, um, and that was sort of start of, uh, it was early 2020. And as you're all aware what happened that time of year, I'm pleased to see, you know, it was relatively straightforward pregnancy. Um and he was healthy, happy baby. But I think that was a combination of factors really that led me to, to consider and ultimately apply for less than full time. A big one was COVID and the impact that had on being distant from our families, Rosie as well suffered as postnatal depression about six months in. And that took a big toll on, on every everything. And she also had this, you know, she finished her A CCS by that point, but was looming interviews for um anesthetic reg posts. So with all of that, you know, sort of hanging over us, the really logical step was for me to say, look, I want to reduce my hours. Um And I was pleased to say that the process actually was really quite straightforward. My TV is very supportive um rush on what you said about that triad. I think, I definitely agree with that. And at the time I applied, I had that help. That was only six months through a job six months into a job that time I applied. So I knew the system, I knew the consultants, they all knew me that helped. Um So yeah, applied in October approved in December started in April. So a little bit of a time delay to getting it, but it was relatively straightforward as I went back less than full time, Rosie then had anesthetic interview. Unfortunately, she didn't get offered a job in seven is very competitive region, but was offered her second option, which was a number up in East Midlands. And now that's where her, all of her extended family is. And I think on the backdrop of the fact that I've just said we essentially took the decision that it probably made more sense to be close to family. I'll talk a bit about the childcare, but essentially being close to family was a very big draw. You could afford a bit more in terms of getting a bigger house and settling down somewhere. So she started up in East Midlands in August 2021 I approached my TPD immediately to say, can I have an entertainer? We transfer. Um They're very happy to allow me to do that and it's a national process. Unfortunately, it's quite a informal process. There's lots of paperwork you send out the application a few months later, you get an email back. I'm sorry, we couldn't make you an offer because there's no space. Please try again in six months time. So we continued our trend of tag team parenting, lots of driving up and down. It's not even bringing all over with us. He spent a few days in Bristol with me a few days. I've been not in with her and that whole period was very chaotic. Um I think the impact of that on my training actually probably slightly minimized by COVID because it was still a slight reduced um training sort of environment at that time. So we're still, everything's still quite tumultuous. I'm pleased to say that the second round of applications um I was successful and started up in Leicester in August of last year. The I would say my training generally hasn't been negatively impacted by the less than full time. It doesn't mean a bit more organization. I've had to be a bit more proactive. It does, it makes it slow in building trust with trainers in terms of letting you do things and them knowing what you can do in that, that sense of being present on the firm. I consider myself perhaps a little bit more of a shift worker than I was before, you know, as a corps trainee. They're long hours after hours. Um I think there's a slight culture around that, that's probably got some negative connotations, but I feel my free time is now more precious. Um And as such, you know, I haven't done a locum shifts since 2020 for that reason. Because, you know, when I'm not at work, I don't want to be at work. And, but when I'm at work, I'm, I'm fully at work and that, that's slightly aligns with the way we've arranged our childcare, which is such as tag team, tag team method. Um in terms of what would have made things easier. Now, we did link R F one applications, but there's no, as far as I understand, there's no way of linking applications at S A chair or registrar level, despite the fact that seemingly would be feasible. Um I think it touched on what professor meant and Rashaan had said about flexibility and that flexibility really is the key word between us. We've had nearly three years of applying for transfers. Um And that really has just delayed us getting to the point of being able to have a family, which is, you know, it's less than it takes some people to fall pregnant. But it's, it's just another thing that could possibly be improved within the system um in terms of childcare options, we, so we ultimately settled on this pattern of doing it ourselves. And that's partly because, you know, most nursery hours don't fit with, with our hours. Rotors are unpredictable. We do on calls two nights, we did have a nanny um covering the Wednesday for a couple of months. Unfortunately, just gave her notice. After a couple of months, she had a better offer, a better job. Close to home. So you, if you can informal childcare with, with family, to me is, is the probably the best way to go. But it's, that's not possible for a lot of people. And ultimately you end up paying for the flexibility if you haven't got that. I think those of you that read the re the parents and surgery report would agree. It's a great starting point. I think that key word is flexibility but also sort of empathy into the wider training structures. It's interesting what you said was showing about the triad with TPD the managers, the colleagues. I think actually most people's consultant and peers are sympathetic and you know, they're, they're happy to allow you to have flexibility. But I think the bigger change needs to be in the systems and that needs to be standardized as you said. And hopefully investing in that and addressing it will address a lot of the growing issues in terms of dissatisfaction, burnout. Um So hopefully, that's, that's helpful to some of you to hear about that. And I'm very happy to take any questions. Everyone wants to drop me an email again. Very happy to, to answer anything by email if you'd like me to. Uh thank you very much. Thank you. Thank you so much, Chris. That was really great. And thank you for sharing that experience. I think your experience is actually helpful for a few of the questions that are coming in um to uh, to help trainees, think about how they might, um, uh, deal with some of their situations as well. Going less than full time. It's something that we've heard of, but we've often heard that it's, it's not easy to apply or, or two to get when you do apply. Um, and I think internally transfer is another thing that we've heard of, but again, not clear how quickly it should be processed. Um, even if, even if whether or not there are guidelines for that, I'm not even sure. So that, that, that's really helpful to hear. So, um, first off, I, I could, um, we've got a couple of questions and I have some of my own. So, um, this is to the panel. So, um, one of our, one of our audience members notion has suggested, um, said my husband and myself are both working in surgery and we're struggling with childcare in terms of cost and timing as a daycare, send him home if he has a cough or fever, which is quite frequent when they're going to nursery. Is there any support available for this? I put it to the panel. What can we do? Um What can you think of? Yes. Should I come in there? So everybody in the country is entitled to 10 days on paid childcare a year. So I appreciate that's only 10 days, but at least it's 10 days worth of on pay child uh day off for childcare. So if you do have an incident, so for instance, happened a lot during COVID, I think where people were having to sort of um uh any child with a snipe sniffle in COVID was taken out of the nursery because everyone thought they got COVID. So people were allowed to use that. I think actually though, I mean, what we really need is a culture change. We have to be kind to each other as colleagues, you know, and if one of my, I have colleagues who have younger Children than I have, and one of my colleagues has to go home to pick up his child from school because they've got a sniffly nose, we cover them because we all have different reasons for wanting to leave work early and none of it is to go and play golf, which is the old fashioned reason for thinking where consultants were. It's normally for something really important like picking up your child from school. And as long as you're not sort of doing it every single day of the year, I think we just need a degree of flexibility amongst ourselves. We need a culture change. But yes, there are these 10 days that you're allowed to take, um it's unpaid, but you're allowed to take them at short notice for child, for caring issues. So notion could raise that with her manager that that should be allowed to take this legally. Okay. Another question uh from the audience member Aaliyah. Uh I was wondering how much time a woman is granted maternity leave and how long this could extend their training? Assuming they decided to have one child during training, Victoria, would, would you Victoria? I can't, we can't hear you for some reason. I'm not sure what's going on there. No. Should I come in while Victoria's sorting her? Sound out. Sorry, Vic. Um So you're allowed one years parental leave and that can be shared. And that's something that a lot of fathers are not being told. This is what we're saying about. There's no sign posting out there. You can take a year as a mother. You can also share it with your other half, be it the other mother or the father or whoever. Um And we, in fact, we spoke, we did speak to a couple of um um surgeons who had shared their parental leave six months and six months. Um the two parents and they felt it was so much better for bonding with their Children. So it's the sad thing is that a lot of surgeons um find that they shouldn't take a year that they feel the pressure to go back to work and they'll take six months and then they'll come back. And then there's this issue with, when am I still breastfeeding? And where's the child care coming from? And I feel guilty as a parent, but it's obviously up to the individual. Um and the same ago, same applies for adoption leave as well. And whether Victoria wanted to add anything to that, she looks like she wants to. I think she does but I think her audio is not working. Perhaps Victoria you can um log off and log back in. Maybe it'll work. Yeah, you do baby sign language vic. Uh You're just trying and meet yourself again maybe right now. No, it's not. It's uh yeah, there's something like, okay, Chris, you had it. I was just going to say that I wasn't aware of the shared parental leave until halfway through my partner's maternity leave. And it probably would've been something that we would have done had just had it been signposted and been more widely. Um, I had an awareness of, um, I just wanted to come in here and ask the panel. I'm really interested in hearing what professor meant, thinks of this, but I've always wanted this. Uh, I mean, over the past few months after reading the parents and surgery recommendations, do you think we should, we should, um, uh, disseminate a mandatory training module for TPD S heads of schools. H E uh I know people hate mandatory training. But what is the best way of getting culture change? How, how is it, how can we get this information to them because it's reports been out for quite a long, quite a few months now. But I don't hear a lot of noise and talk about it. As much as I would like. Yeah. Um, I've had two T P D s as a higher training now and I've got to say they've, they've both been exceptionally supportive. Um, they're both parents. Um, which obviously helps. I think a lot of, um, people that take on those roles tend to be more minded of that. But it might, it might be that, I don't know how the, I don't want to, how they get trained in terms of TPD training as it were. But it seems logical that this, this should be included in awareness of this for those that aren't parents or having some firsthand experience of it. Yeah, thank you. Um So, so what I suppose first artists say we're working on it. Um We did want to wait until the Nuffield trust report came out and that's only been out a few weeks now. Um And we are working on putting together a package that we can disseminate and we will work with hee with the T P D s with the J C S T. Um I've been a T P D twice myself, both for core training and for higher training. Um, and I wasn't trained in any of this and I picked it all up as I went along and I had a trainee who, who's other half, um, got a job somewhere about 200 miles away and said, well, I think I just might need to take a career break. And I said, well, why are you taking a career break? He said, because my other half, because I didn't know rather has got a job to undermines way and I need to do the childcare because my other half is starting a new job. I want her to settle into her job. I'll just take a career break. And I said, well, why don't we just see if we can get you a new p, you know, and after program experience, we, we tried to do intervening transfer wasn't gonna happen quick enough as we've already seen, it doesn't always happen that quickly. And in those days, there was only a one year, one window a year, I think now there's two windows a year for I D T S. Um So I just contacted the TPD near where the, the other half was going to work and said, look, we can either do a swap or can you fit someone in? Can you guarantee that it's a training post? It's an additional training process, not a program experience, but we'll call it a training post because it will be ready to be recognized. And that's what we did. He went up, he spent a year up there, sorted the family out, sorted the wife out. She got an I D T down, down to, down to where we are and then they were okay after that. But, but it is a case of just the T P D S, as you say, being flexible and having their eyes open and realizing that actually this is just life. It's not something that's different. People have families, whether there in surgery or outside surgery. And we're just trying to facilitate, facilitate things for our colleagues. Yeah, that is incredible vic, you're still, you're still not working. No, it's OK. Done it this way. But if you can hear me now, now we can, I was just going to say, but that relies on you having a place available to that person to go for that, that to go to. So I don't know if there is a supportive TPD but you keep hearing where there are many, many stories where they're, they might not be such support and there might not be a training post available. And I think that's what's difficult, difficult. And then the second thing to say that I, when I, you can hear my question um was that you exchange your training with maternity leave by the amount of time that you take off the maternity leave or paternity leave. But that's if you're on the old system, if you're on the new system, which you will probably will be because the old systems about finishing the 30th of August. Um You, you, it's competency based. So if you want to, you've taken 12 months of paternity leave and you want to do 12 months extra in your training, then that's fine. But if you don't feel competency based, you need that and then you don't have to extend it by that 12 months. Um And that should actually help feed the females as they're the ones that often have the time off more and carry the babies. So I was going to say Roshni, do you have your hand? Yeah, it's just coming back to your question, which you asked was, should people have mandatory training? And I think so, people hate the idea of it, but I think if you're in a leadership position, um and you're going to be in charge of, you know, lots and lots of trainees um as a consultant, then absolutely. Um It also means that it helps them to understand the language around this as well because it can be very sensitive and sometimes people don't know what to say or when to say it, how to say it. So just something is good and if you're going to have sort of policies, they need to be flexible because people don't all need the same thing. Not, there's not a one size fits all. People react differently and at different points in their journey, whatever they're going through, they may just need something a bit more bespoke or different. That's what I would add about that. Absolutely. Um Speaking of uh flexibility, there are a number of comments and questions in the uh that I'd like to tell the panel and get your comments and views on on Stella. Dille says frequently return to work strategies have not been practically available. Is there a way of ensuring that it is as it is very frustrating, returning to work with no access to any supported return despite trying, she also adds also, is there a way of incentivizing return of on site nursery starting at 7 30 AM at at least three closed post pandemic and this would enable full surgical working day with childcare that doesn't cover it. Yeah, just to say that h he does have the support program but it's not well publicized. Um It's um, the support program is for anyone who's been out, whether they've been out in research, whether they've been out because they're off sick, whether they've been out on parental leave and it's there to support people come back into work. Um And there's money behind it, but a lot of the, I'm going to call them Dina and I'm not called Daenerys anymore, but a lot of sceneries don't, don't seem to be advertising it to their trainees. Um And it's just really, so this is what we say about. We need to sign post people. You know, we need to educate the T P D s. Um But we also need to make sure that all the trainees know about things so they can ask their T P D s because we all know even from way back when, when I SCP came back in, it was it was the trainees that drove it, not the trainers because the trainees knew they needed it and therefore they trained their trainers to use. I SCP we can do it the same way around with this information giving as well. You know, we can get trainees to, to say, well, we know this is available to me, show me where it is prof what do you do if, if a trainee, um, goes up the chain of command and still they're not being helped to go through the through, through support. What who can they contact? Um Suppose they've contacted Stella's issues, contacted Champion and the local person. No one was very helpful in um in ensuring that she could return to work based on those strategies that you spoke about. Who, who could she go to next? If the TPD supposed wasn't very helpful, go to the dean, go to the associate dean and failing, failing that, go to the S A C liaison representative who is the person who sits on the S A C, the specialty advisory committee who is also a surgeon and who advises from outside that particular Dino A patch. So I used to be an S A C liaison rep for a different patch. So there's always somebody who can go and just keep going up the chain, you'll hit somebody eventually can I also suggest something. So the return to work there is this money. But so you obviously get the courses that they, that you can get, that you can do. But the, but the return to work is a pot of money that allows you to go back to work and not be on the on call rotor or come in on days and you can use it as you see fit basically because what happens is, is you apply for it. So it's a bit complicated. It's a bit annoying. And when I did it, there wasn't that much support, no one knew about it. And I had to do lots of investigation on my own to find out what it was. But eventually I found out that I think it was like, I think it was 2000 lbs or something gets given to the hospital and then that it just goes into the hospital money and what you, but you need to be really careful about how you do it and how you organize it. So if they think you're coming back to work, say on the first of October, then, then they put you on that rotor and that and then you then, then you feel like an annoying person saying, oh, can you cover my shifts using this money because they don't know what money you're talking about. It's already gone in some hospital fund. So what you need to do is play the game, which is say, say I'm coming back on the first of, I don't know, November a month later, then you wanted to come back. But you, but you say I'm going to come in and do shadowing or I'm going to come in and do non on call shifts between the first of October and the first of November and that 2000 lbs is for you to help fund your, your. So it's not keeping in touch days, which is another different thing that you have to play a ridiculously game about get on the days that you do them so that you don't lose your maternity pay or paternity pay. But, but, but the return to what thing can be done and even if no one else knows about it, as long as you find out all the forms, you fill them all out correctly and then you go to your H R and say, here's this, here's and go to your T P D and say, can you sign this? They're, they're happy to do it because it's not going to really affect them and you're just going there as an extra person on top of the rotor and then it can be a phased return, but you have to find out about it often. People don't know about it and I think that's the bit that could be done better, but if it's not done better, don't let it put you off is what I would say. Mm Excellent. Um I think we are almost where it's eight PM already. Um would, would, would, would everyone mind if we have a couple more minutes, there are just one or two more questions. Is that ok? Um So Mary Vince's, even without illnesses and emergency childcare, it can be pretty difficult to leave work to reach regular six PM, pick up from paid childcare. How can leaving work on time be normalized, facilitated for people who don't have free intact family cover? I mean, this comes back to having on site childcare services. And I know that's one of the recommendations. How do we, is there any way to force this through? How can trainees due to um try and try and in uh get get this uh in their local hospitals or get, get a talk, get people talking about having this in their local hospitals. I think it's, it's a recommendation and obviously um we are going to advocate that from the college. I don't think we can force anyone to do it. Um But I think as with anything, the more you talk about it, the more people are going to take notice, but it may take a while. The other thing of course is coming back to the culture within your department. Is there going to be different days when different people have to leave early and you just need to for the time being, share it amongst yourselves, be kind to each other. Look after each other. Um And I know that there will be some people will say, well, I don't have any Children. Why do I, why is it always be? But it won't always be, there'll be other reasons why, where they need support as well. We support each other in everything we do. But I agree that there's, there is no way of forcing the trust to do that at the moment. But what we can do is campaign for it and advocate it. Yeah. Absolutely. Uh, absolutely. I'd say, you know, it's so important also to recognize that the NHS is 76% female. Um And you know, this is not just a training issue and not just a surgical issue. If you want wraparound childcare within hospitals for our workforce, it's really something that we need to campaign hard for. Absolutely agree. And I think what I'm, what I'm hearing from all our, our uh our audience and our panel of speakers is that we need to be more kind to each other and move towards um adopting a more flexible working environment. Uh not see this as a negative but as a positive force for change. Um I am acutely aware that we're running over time and I think we've answered everyone's questions if you, if, if the panel members have any last uh comments of use um to share, happy to open the floor to you. Um Otherwise I will hand to, to mow, thank you so much, everyone for being here. Thank you, professor meant for that in credible talk and for leading that incredible piece of work. I think you've really started forceful change and I'm hoping for posterity, there will be definite change book. Thank you very much. Uh Lea and thanks everyone. It was very, very interesting and very useful and I can see the uh the comments coming and, and, and, and I think meeting like this will make people were more aware about the rights that we have as parents, what we can ask for and how we can make things better. Um For, for those who joined us today, you will get a feedback form, please. It's our first meeting to do on, on middle. So please give us some feedback about what you think the day was and what we can do to make it better. Uh I'm just going to share with you very quickly what we are have having next from the Dukes Club. Uh Our next webinar would be on, endorsed between ing and the attorney academies. Uh We, we've, we've got all, almost all the, the training academies leads on the evenings to please join us. It's a chance to, to here and ask questions about industry training and how we can make it better. Uh We have also got a proctology or two which would be a series of uh one day course, uh face to face meetings with uh collector ST 7867 and eight twenties across the country. We're starting in East England uh in April but we will cover every single denarii over the next three years again. Keep, keep your eyes on that for uh for the for medical students. Actually, uh court trainees, uh surgical uh C three S T four. Uh We're running a, a new course, uh called the fundamentals, of course proctology. Um It's coming on the fifth of June on Maidan and it's open for anyone again for free to come and, and, and it's basically, of course that we aiming to give to uh to the junior who will be starting the day to day practice as a colorectal junior doctors who will be looking after patient's doing clinics and what you expected to do to see and do uh on your day to day practice. Uh And this will be then followed by uh again, a face to face practical course on the basic of uh Kuala proctology. Uh You're also having uh TME and semi categoric courses as well as an abdominal wall uh reconstruction and, and, and for the first time, we were only a virtual fellowship in advancing collective cancer. So, um a lot coming from our side and, and, and, and we, again, we, we are very keen to listen to feedback and uh anything that you would like us to do, please get in touch. And we have obviously our uh whatsapp group. Uh You can obviously get in touch with us on Twitter. Um And again, thanks. Thank you very much. For all, all the abandoned and, and for Gideon for organizing this tonight and I'm sure we'll have more about parents and surgery. And, uh, I hope you all have a nice evening. And thank you again.