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Hello, everyone. Um Almost good evening. Now, thank you for sticking with us all day. Um So I'm proud to introduce the next session, which is the silver scalpel lecture and meet the silver scalpel nominees. I'd like to introduce Professor Professor David. Oh Regan to this stage, who will also um chair the next session. So please, thank you. Thank you very much. Indeed. It's always a pleasure to be here at the Silver Scalpel Awards. The future of Surgery is in this room. Let us think of education as a means of developing our greatest abilities because in this room, their skills and talents, if realized hopes and dreams which fulfilled can translate to the benefit of our patient's our profession. Our hospitals are organizations and the N H S, but it's not going to go anywhere without a good teacher. And that is why we started the Silver Scalpel Award in the year 2000 and this is how we measure them up. Is it not a giveaway award? There's a four interdependent stages that are non um IZED and you the trainees nominate your best teacher, another cohort of trainees blindly score on an Excel. Waited template and those who score more than 3.60, yes, to two decimal places are likely to be shortlisted each year between five and six people. And thanks to Sophie and the Acid Committee, they then undergo a comprehensive 3 60 degree interview, including them appear a trainee assistant and those are all then redacted and you end up with 100 pages of comments. During this time, I write the CEO the medical director, the postgraduate dean to ask if there's any reason why they cannot proceed with a reward. And the president's of all the Colleges of Ireland of Glasgow, of Edinburgh and of England. And a patient representative pour over essentially 90 pages and choose the winner. I asked them to rank them and apply a formula one score ng the top three I pass on to professor Sir Bruce Keogh. He continues to do it but I asked him as he followed on from Liam Donaldson. And then Bruce Keogh is the medical director of the N H S and he chooses the winner. We've had 260 trainers over the past 22 years and you can see the distribution across the specialties is as one would expect. And these individuals and teaching hospitals, district general hospitals, north, south east and West. 111 have been shortlisted and they have been 22 winners. This is the role of honor. It's on the website for you to pour over and this is what it's all about. A humble trophy does now become coveted and has national recognition for good reason. And with that in mind, I would like to invite to the stage, Peter Brennan silver scalpel award winner of 2022. Thank you, Peter. Uh David. Uh Ladies and gentlemen, I still feel immensely overwhelmed. I think the word is with uh with the silver scalpel. I never thought I'd even be um nominated, let alone shortlisted. And so to win, it is the most overwhelming experience. Um uh And as you mentioned, David, the level of rigorous nous that goes into this makes it even more even more humbling. Uh I've used the last year to carry on doing what I'm doing. I empower trainees in the operating theater in the outpatient clinic and all the national work that we're doing trying to change culture. Um you know, bringing change empowerment of trainees. You are the future of surgery without you and without you having the best possible experience, we do not have a bright future. So we've spent the silver scalpel has been going around as you can see and even, and even at college events, uh this was the Christmas dinner after dinner speech. Um It's about empowering trainees and Tim Mitchell was there and knew and others. So, you know, every opportunity I used to empower trainees of the future. I'm sorry, consultants of the future. Um We ran a Christmas webinar and you'll see on the top middle there is Colin Melvin is the medical director of the G M C unfortunately has been delayed. He's coming this evening. His train was slightly delayed. Um and then next to him, Ezeli who is a medical student. So you know, the power, the um you know, they are equal. As far as I'm concerned, the medical director, the third year medical student and John Hardy Hardy there, it is really, really important to lower hierarchy. Yes, there has to be some high hierarchy of course, but to lower hierarchy into value and champion uh people from the earliest, earliest stages, possible surgery is a fantastic career. We have to change culture uh to make it even even more exciting for the future. So what I thought I'd do is I'd use this opportunity um to actually talk about empowerment with, with my human factors hat on. And you know, even even in, even in a team briefing situation, how many of you I wonder is actually asked to lead the team brief for me, our trainees regularly lead the team brief. You are a vital and essential member of the team, you need to lead the brief. Um So we're just going to run through some of the things which I think you may not have thought about but certainly uh improve patient safety, improved morale, improved team working. So how are we perceived as individuals? And so as a consultant for example, you might be perceived as that person on the on the left there. Uh and a trainee on the right. No, that is not, that is not right. Is it, you know, we have to actively lower authority gradients. Such the trainee can actively challenge, can speak up, can question, can ask device without fear of retribution. So important and when you put on a Lanyard, so I'm so I've got a real college of surgeons that immediately or potentially creates a higher hierarchy. So it's, it's our behavior that makes all the difference. Um On the flight deck, I would never compare aviation to healthcare. I think that's really important. But on the flight deck, the most senior captain there on the left can be challenged by the most junior first officer without fear of retribution. And that's why or at least one of the reasons why aviation has such a great safety record. Uh So here we are the team brief. We have a core training at the front there and she led the team brief, she's empowered, she led the team brief, everyone's happy, great, great morale boosting um For the for the team wearing a name badge uh on a hat, for example, that's Matt, he's at least this um Paul Sadler will obviously obviously know who that is. Um that does not lower hierarchy that just tells you who he is. Um And what and what he does, you have to actively is your behavior that actually changes. Um, so a short little paper we published in the BMJ about, we need to empower junior doctors, um, uh, to speak up personally. I don't like the word junior doctor. I think, I think it's, um, slightly belittling but the BMJ would not, would not let me change that. Um, so engaging with checklists as if your, your own life depends on it. Many of us pay lip service to checklists. Yeah. Yeah. Yeah. You know, um I see it in a lot of studies going around. You go, you go around, people want the checklist over and done with as quickly as possible. But if you engage with it is if your own life or limb depends on it makes a massive difference. Uh This was the Hague Osaka in 2015. A container ship capsized in the solent. There were 220 ticks on the checklist. 220 ticks. Uh Yep, yep. Yep. Yep. Yep. And there she went over, she went personally, I think we probably need a much shorter checklist. Probably five or six things is probably all you need. The longer the checklist, the more complicated get people, people disengage. Um So empowering trainees. So if you look at most of our publications, they will be led by a trainee always. So this is Isabelle Short little paper we wrote in the rcs about how, how to W H O learning, learning from aviation putting your own life there on the line, you know, if, if an airline pilot makes a mistake and doesn't do the check this, everyone's gonna die, including them. So, so thinking of yourself as if it's a member of your family. Whoops, or golly thinking of yourself as if it's a member of your family or you on that operating table, ensuring good and effective communication that David was one of your, one of your silver gap of criteria. So, so hopefully I scored reasonably one on that one who knows? But um but you know, it's all about body language, isn't it? It's about how we relate with others. And I think apart from certain closed questions, Martin, have you got the right ct up? Yes or no, you know, obviously, but most of the time it should be open, it should be two way and again, just valuing trainees, you know, talking to you as a colleague for me, all trainees, irrespective medical students, you are colleagues, slightly different parts of the train journey, but you are a colleague rather than a medical student foundation train, you are a colleague, respecting all team members. Um So John Hardy is there, this is, this is a paper that's had huge, huge numbers of downloads. Um So just when you say something, you think that the the the team has heard and understood it, a they might not have heard it but be have they actually understood what you said. So, so sometimes getting a bit of repeat back or feedback, can you just confirm David, what you've said is that, you know what I've said? Um And then, and then you, you know that the message has been heard and understood, um Thinking about the what if situations um and you know, planning ahead and as trainees, you are, if I'm operating, you are my my eyes and ears while I'm concentrating, I am relying on you to actually look at, look out for things. Um And hope hopefully I'm not going to make a mistake, but I'm looking out for you in the same way that when you're operating, I'm looking out for you. That's what good situation awareness is really all about. We've done some work with the red arrows and we've published with them and these guys have the most unbelievable situation awareness as you as you can imagine. Although recently, perhaps I shouldn't be showing this slide because there's uh there's bullying and things that even goes on in the red arrows, which I think is totally abhorrent and I think the colleges need to be doing more to tackle those behaviors. So if something doesn't seem quite right, uh And we mentioned this in the uh in the proximate, uh talk, talk a little while ago. If something doesn't seem quite right, please just stop or even say to the say to your boss. Look, I'm sorry, please, can you stop? That should be confirmed at the team briefing stage. Something doesn't seem right. Please just stop. Let's just stop, stand back from the situation. Uh see what's going on. Uh And John and I have published this uh in the in the Annals we've took with Tim Mitchell as well. Um uh you know, stop, think about the patient, think about the procedure, think about the people, you know, all too often. We're sort of, we're quick and we carry on but, but none, no, no, we can stop. And you as trainees, you, you have the power to say, look sorry Mr or Mrs. So and even first name terms, which I think is great. Uh I'm sorry, Martin, can we just stop for a second? Just, just stand back. Many complications would be, would be saved that way. Um So minimizing distraction. So um this was a paper we published in, in open heart. It's one of the leading cardiology journals around distraction, the cardiac catheter lab. But actually distraction happens wherever we work, doesn't it? You know, we're operating. Can I interrupt? Can we do this? And then, and then you carry on operating suddenly, you find that you've made a mistake. So, you know, um it's something being, being aware of distraction and the risk of error associated with it. And again, if a surgeon is operating a consultant and there is a distraction, us trainees have the power to either to say sorry, you know, Mr or Mrs Santo is doing this. Please. Just stop, please. Not unless it's a life life threatening situation. And these are some of the distractions, the phone going off, case irrelevant communication happens, happens all the time no matter where we work. Um, and I think finally, um taking regular breaks. So John and I drove up from Southampton um, at about three hours, we've had enough, we stopped, we had a cup of coffee, something to eat and yet we can operate for eight or nine hours nonstop. Can't we? What does that seem? Right? And the answer's no. And if you look at the published studies, once you get to three hours, your concentration level starts to deteriorate and you don't even know it's happening because you think you can operate for that length of time. So we, we would recommend stopping at round about three hours if it's safe to do so. And that's absolutely great for the team. It's great for morale. It's great for everyone. And you ask the nurses and they're like, well, you know, I'd like to work with Peter because we always have a break at three hours makes a huge, huge difference. Um uh Water, even, even if you lose a kilogram in body weight through perspiration, particularly over the summer, your analysis and decision making falls by 20% and you don't even know it's happening because it's a very, very gradual, gradual process. Um So eating and drinking regularly and this was, this was a paper we published in the BMJ 2019. It's had huge numbers of downloads, but it's just obvious really. It's just common sense, taking the brakes, making sure you're hydrated, making sure you, you eat regularly. Um This is one of my very good friends who's an, an enormous bodybuilder tells me he's not on steroids, but I'm never going to argue with him. Am I really? But, um, you know, he says, he says we need, we need to eat regularly. How many of us come to work, not having breakfast. And if you do that, you're effective in a fasting state, you're not optimized, your brain isn't functioning in the best way that it possibly can. Um And many of us don't drink enough during the day and then you see your urine's really concentrate and as I mentioned, your analysis, decision making falls. So, so as trainees, hopefully the briefing stage and this is where we need to change. Culture is a should we, should we have a break, Martin, you know, let's let's just stop, walk away because because if you as a trainee is feeling tired and you need a break, it's almost certainly that the rest of the team as as well, but culture needs to change and that needs to happen in the operating theater and being driven by the G M C and the colleges. And we're talking tomorrow with the medical director of the GM see about this very subject. So the, so the GMCR really, really trying to change culture themselves as well. Finally, David and I'm actually gonna finish early. Uh This is a well college of Surgeons course that's about to be published online. And um just an example and you see look authors John Hardy. So, so John is empowered as a trainee as the lead for this online course and there's actually a face to face course for the record surge of England coming in the next six months or so as well. Um So hopefully this is going to be available. This was written last summer, but there's been some platform hosting issues. Uh So it's so it's slightly delayed. Um And we've used a lot of examples from chorus the confidential reporting of error in surgery. Um You know, a fairly simple, hopefully fun interactive course on situation awareness lowering hierarchy, just culture um and, and causes of error. So that's so that's of course, hopefully that's coming very very soon. We've already touched upon the PPP uh as mentioned. So um it just remains for me, David. Uh I'm actually four minutes early because I, because I know he texted me to say, could we could do the thing. So um um obviously, I'd always obey. So I just like to wish the finalist the very, very best of luck. In fact, all of us, all of us that are, that are trainers at whatever level as trainees um teaching foundation, a medical school dot All of us are winners. Let's be honest, if you, if you go that extra mile, if you give the time, the commitment, the care, the support, all the things I've said. If you give those to the next generation, you, you are a winner, period. So David, thank you so much. Indeed. And um um as I say, I'm very much looking forward to the next, the next bit with the uh with the finalist speaking up. Thank you. Thank you very much, Peter four minutes ago.