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Um And I have the pleasure of introducing our next speaker, uh Mr Goldie Kira, who is a consultant upper gi surgeon in Brighton, alumni of our local Liverpool Medical School um and passed Presidente of Asset. Thank you so much. Appreciate the invites. And firstly, can I say thank you for the invite and also well done to the Asset Committee. I've been to many, many Asset conferences over the years and this genuinely is been a pleasure has been run amazing so well done to the to the team. Um And well until the everyone working behind the scenes as well. So this section obviously starting of with Roberta's fantastic documentation of how difficult it is on on the ground. And I think probably what's been reflected in that fantastic survey is the tip of the iceberg, as the question said, uh is surgery and outlier, you know, are we worse than other specialties? Are we the same? You know, is this compounding, I think on the ground? Yes, it is. But to get actually the data for that to actually make a difference with the colleges, with the politicians, I think is where asset comes into its own to do that. So again, you know, the previous talk, talking about money and talking about how to deal with your finances, compounding pensions. Um, you know, wage slips, all that isn't told to you. You know, I discovered it by accident. Um, and all of that stuff, you know, you do need to know and is, is ignored. Now, the same for resilience. So again, this isn't a wish you washy talk. Um, sorry, it's not a linkedin, you know, type of talk. It's quite gritty. So there is going to be, you know, I do need to, you know, say there are some difficult themes this, that this will be discussed. And I say that and I presented that hopefully uh you know, with, with that in mind, but, you know, we are going to discuss some important and difficult themes in that, in that regard. So going back to myself. So I'm alumni of Liverpool Medical School. Um been here since the 19 nineties, stayed here as a uh junior doctor S H A registrar and then went to Australia and then went up and down the country for, for fellowship. So currently in Brighton as, as you've been told. So my job was also changed. I've been there 11 years. So my job was morphed into more into the leading uh surgical medical school, um uh an assessment and all sorts of other things and portfolio type of things. So things change and what you start with also doesn't have to be where you end up. All right. So that's the first thing now I grew up in Birmingham. So uh inner city Birmingham and essentially it was a really poor school. It was no funding. My school was actually closed a couple years after I left. Um So that's the school on my top, right of the screen. So fantastic memories, some great teachers. But yeah, knife crime was, was was was a big thing. Police. Yeah, we were scared. Um So all those things we had to deal with, there was no access to the internet didn't exist. So your your world is much smaller compared to now when you know, you have got access to outside of your little bubble. But yeah, burning was fantastic. The rich vibrant area and obviously I got involved in that regard. Always wanted to be an astronaut. So for me, I did maths, more maths and further maths and um my my predicted grades were not in the same league. So I hadn't gone to a posh school. I got rejected straight away from, from what I wanted to, to do, which was astrophysics. Um Essentially um it made my mom happy. So I went to be a doctor. Um I got one offer uh Liverpool and got the grades and and then was here as a as a doctor. So I came to to medicine purely as a last resort purely cause I couldn't really think of what else to do. Um And then really enjoyed it and then stayed in Liverpool, but I had to do extra biology as you can imagine having done all the maths that I had come from. So I knew medicine is going to be hard. So all of, you know, that it is uh competitive, you know, high stakes is, you know, you fix things, etcetera, empowering, all, all the things are written about. We know that. All right. So this isn't something that I'm telling you that you don't know. All right, that, that's fine. We know that you've got uh a support structure that is going to give you um you know, respect, you do have the opportunity to grow. But we also know there's long hours, we know that you have to worry about work life balance and in stressful conditions. This I think is goes without saying however, what I found out later uh is at what personal cost does this come to, you know, the long hours that we do, how it affects us, you know, just not just from um from a uh you know, from a, from a personal point of view, from, from a relationship point of view, uh family point of view, you know, where that, that leaves us. So the issues is how much um you know, guilt we feel on a daily basis. So it is not to put you off, it is not to put you off but it is to give you the, the ammunition to, to deal with it and to talk about it. And I think, um, you know, in the metro world of, of medicine, metro world of surgery, um, you know, it is hard to talk and who are you going to talk to? Who you're going to report to who, who your friends and family that you're gonna, you know, get to support you in this time. And it can be quite a lonely place when you have got um you know, issues of um you know, patient's um not making it to having complications or dying, um and high risk steaks and all the associated um uh issues that we had during COVID, for example, as a global thing. But all of that is adding on to the mix of exams of money of, of moving around from Dina Me to do MRI or from place to place in the delivery. So we know that the E W T D has compounded things with complex rotors, with handovers, with all of the issues we have with, with discontinuity. So all of that has not made it better. So we fought quite long and hard um uh asset, producing a mission statements, position statements, talking to the colleges, talking to the politicians about getting an opt out for E W T D. We were not successful and basically has had a breakdown in, in our surgical firm structure. Hand has caused a decrease in our pay. So all of the above is making the current reality to be a surgeon, a consultant, to be a trainee, you know, difficult. Yeah. Um and, and what you need to be aware of that all of us are suffering this how we manage. This is compounded by, you know, our personal circumstances, our family circumstances are mentors. So seek seek help, seek, seek someone to talk to you because the issues of us being damaged by this by having burnout depression, risk of suicide, risk of of leaving risk of losing the rich, you know community that we we could be and you know, just having a nutrition effect where the survivors are so damaged at the end of it, that what we what we were left with. So again, this is not to put you off, this is purely to make you aware that it is now more talked about than it used to be. Um you know, what contributes? Do you burn out the most? So is it paperwork? Is it spending too much hours at work? It's, you know, lack of respect from colleagues. You know, I've been shouted out recently by international situations, not just by patient's, you know, obviously, uh but by managers, by colleagues, you know, uh what what we come to when that's happening. So all of this requires you to um to understand how to do with those difficult aggressive situations, how to understand that when you're feeling burnt out, when you are not responding to a patient or to the family or to uh you know, a manager or in an email, you know, your first intent is, isn't, isn't to answer it correctly, how you can dial back and take time and understand that you are showing signs of this and showing signs of, of living lived in stress. So, resilience isn't ignoring, that isn't putting on post after post on linkedin about how empowered you are by your day, it is about dealing with this on a on a regular basis and in such an amazing fulfilling job. Yeah, you heard um all of the speakers this week, you know, starting from, from obviously mobile hours from the college present, such such a empowering job that we got such a privileged position that we're in and yet we have to balance that with all of the above. Yeah, with all of the issues with, with, with financial problems with all of these problems here. So it's hard. So we, we know for sure the data exists that physicians and doctors and surgeons who, who are, you know, experiencing these issues do contribute and have worse outcomes, think of that, not just patient satisfaction, but actually worse outcomes. So your risk of causing harm, actual harm, not just satisfaction scores is higher. Now, is that because of communication, is that because you're so angry in theater and so aggressive and so mean and so that people are like, well, I don't talk to him or her. I don't say that or too scared to say that or actually, you know what you built your fire, you go and you know, deal with it. So by having a level playing through, by having the opportunity to discuss and to be open with every member of your W H O, you know, on your checklist that you're talking about everybody that you know them, you talk to them, they will save you from wrong site surgery from missed events from never events. And that is your team and you live and you know, you have to have to really appreciate them. But if you have got the attitude where you do not communicate and you are burnt out and you don't realize it and you that is there, then maybe that is why this is happening. So that's the first aspect of this second aspect, which we need to talk about, which again, I thought long and hard about what to say and what to do. So this is personal to me. So these are personal colleagues and friends named, named mates of mine who I've been, I've been there since 2011. Um and you can see that side so difficult slide for me to, to put on this, on the screen and I've done that almost in memoriam of them. You know, these are three blokes, three men who, you know, didn't uh didn't survive this, this process and on paper, you know, my first friend, consulting Denise, this fantastic guy, funny guy, young kids. Yeah. Second, you know, really successful professor. I mean, I've, I'm just starting my academic journey. Um you know, professor at 50 you know, profound dead against stresses, who knows. Third, again, another professor later, you know, older uh but end of his career, so a respected amazing uh colleagues uh who knows what's going on. But this is local to us. So this is a personal cost, patient cost. So what is resilience? Yes, we're going through this side at home and said daddy, why you give me this talking resilience? You're the first one to cry the me fee. What are you doing that for? Why are you punishing yourself? So, yeah, I know I am and I am, I am in that respect, possibly an eye ally, outlaw in my family. I am the crier, but that's okay. I let it all out. But what is resilience? So it's not just the ability um you know, to deal with misfortunes and change. All right, we're advancing despite adversary, we know we're running low, we know that the, you know, the perception is there that were, you know, lazy. We're not, we're not wanting to work. Yeah. But what about the stigma when we're not? Well, what about the stigma when we are physically? Not? Well or mentally? Not? Well, are we strong enough in a team to so to speak about that difficult add into that the issues with diversity and inclusion. Brighton has always been, you know, an inclusive place and has a reputation for that. But I've not, I've worked in other places were not that, you know, um progressive. So what about the issues of, of equality, diversity and inclusion, add that into the mix of the stress is that we've already talked about and no wonder colleagues are leaving. No wonder colleagues are harming themselves and no wonder colleagues are having issues. So, resilience is dealing with all of the above. All right, and still being able to, to deal with the reality and still realizing how empowering surgeries and how needed we are now necessary are. So it's not passive. That's what I'm trying to explain to. It's not something that you're putting up with. I really think that you've got to be aware of social media and the toxic positivity. All right, I had to have a break from linkedin. Honestly, I wasn't well post COVID. Um So sat in, sat at home Saturday night section, um you know, getting food at the door, you know, everyone seen me with mask on instead of Lincoln was messing with my head. So if you need that, take a break, I'm back on. It's fine. I could take it but I can take it. But at that point, it was not fine and it was toxic, the positivity, but focus on what you can influence. All right. So this is not passive, that's the thing. So it's what you can understand about your gains. We've talked about it before with the debate, you in the wrong place, sort it. Your trainer isn't working, you know, for you, you feel that you're there to fill out rotor gaps, you're there to, to, you know, not for your good, not for your training, not, not working for you, fix it, sort of report it or leave deal with it. You mustn't be passive for your sake, for your mental health and for your family, all right. But believe in yourself, build your confidence. And I know I'm talking to you from, you know, from, from the other side as a consultant of many as I know that. But I also sat, sat where you are and um you know, that's something that if I can explain that to you now, hopefully you'll be, you'll be able to understand that for yourself. So for me, it doesn't matter what resources you have, you need to understand to, to use them. All right. Um And use correctly with the right mentor with right, react with the right support. Uh You know what hell pass it can give you. Um I think we're all standing a better place together. So, so even if you, you're not, you're not feeling it, pretend it, why not? So this is me in uh Cardiff my presidential year, this is Liverpool back in the day. So that was 2016 past presidents'. This is my first day as a consultant and this is my current CV. So always grafting, always building. So this is my non summarized TV. So I keep a big, big bank of a CV. So this is 90 plus pages, everything updated, everything, rewritten, summarize, rewritten, summarized again and again. And I've always done that and then a shorter C V A three page C V. So again, I'm not showing you this to, to, you know, to highlight anything about, I'm showing you to this to explain to what's required and what I've needed to do to go above and beyond. Anything else that's been offered to me, I've done this for, for me and for my training and continue to do so. So I didn't give up on astronaut. I applied to the surgeon courage. Uh Long story short, I applied had to do the swimming zest, had to do all sorts of engineering test, got taken out to Hamburg, got into the top 10%. So I really did think I was going to have a difficult pro chat with my program director in Mersey thinking, yeah, you know, people take time out for research. Well, uh yeah, I got time out for going to Russia to be uh anyway, I didn't get in because somebody really nice and lovely who was a helicopter pilot who uh we obviously as candidates who didn't know who was going to get in. So bless him, Tim got in the sacrifices. Tim had to do so. Tim, young Children had to go to, to Russia for, for, for many years, etcetera. So the sacrifices that he's had to do to, to do what he has is, is fantastic and amazing. C and a really nice guy. But in the future and there's a little plug to the, to our space program. You are going to need surgeons on the moon on in Mars and space missions. So our be here's ground control but you do need, you do not need physicians and dermatologist. So you're your time up in space is coming watch this space and etcetera. So I'm an avid um armchair astronomer. So I am really excited about what the next 10 years will be even that facility. So yes, make this is me, you know, talking about health issues locally. We trying to do training, trying to work out how to do a robot, etcetera. So yes, now virtual reality, the meta wrist. So we again in Brighton are very forward thinking in this respect. So how to train not just us in an amazing, you know, developed country with such facilities that we've got all this access to all these kits, but in low to middle, middle income income countries and to make sure that the metaverse and our training training are teaching is is helping globally. So that's what I do. This is one of my teams. Um and this is some of the research projects at the University of Sussex in Brighton uh that were involved with graphene Crisper, all sorts of exciting things, you know, operating in, in microgravity, uh etcetera, how that affects um operations, bubbles, blood blood flow trauma, all sorts of research, exciting fantastic things which I never even dreamt about in my journey in Birmingham all those decades and years ago. So going back to this, it is not something to put you down. It is definitely something to, to work around and to be strong. Um And if you're not strong, that is fine, that is also good. That is also something that we can deal with. So believe in yourself, it's not passive. So ending at the bottom of that side, which is a repeat slide is um uh an organization called the R N B F, which I'm, you're one of the helpers in that regard. I'm sure you've heard of they will help you. They are an organization, an amazing charity who when I was presidente, we supported the same as the British Heart Foundation of Saint Martin supported last night. So again, look into their website and if you are in trouble financially, your, your family yourself, if there is a, a life changing diagnosis, if you do need support as a med student, as a trainee, the R and B F are definitely a safety net which I um you know, a big advocate for. So my email also is on there. You can also find me on a variety of, of that means. But do you get in touch with anyone? I can help anyone? I can mentor anyone I can give you any advice for? Um Yeah, no problem. I'll help you. That's all. Thanks Mr Care. That was a fantastic talk on resilience and uh what it comes down to and having strong mentors like yourself surely gets us through it. Um So in the interest of time, we're just going to move along to our last talk in this session.