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Um So with this is our penultimate session. It's my pleasure to open our cost of surgical training plenary. I've got some fantastic speakers. Um and it's going to be really interesting discussion. Um And I am delighted to be able to introduce MS Roberta Garage, who is our new, one of the newly elected vice president's of Asset. She's a general surgery registrar in Scotland and phd fellow studying the link between high fat diet and colorectal cancer. She's also the lead for our asset cost of surgical training survey. Thank you. Thank you very much, Matt. I'm Roberta. Nice to meet you all. Thanks for staying until late on a Sunday. So I'll present some preliminary results on the cost of surgical training survey. So I'm going to talk today about a bit of a background of why we're doing this survey. What our vision is, um the data that we are collecting and then go through some preliminary data in the next steps. So, um as it has been doing this work for over a decade and last time it was published, it was in 2017. And as you can probably see, um there's been uh increased throughout time in the cost of training. And we've really looked at financial cost in great detail before where, you know, over a 50% increase in the cost um to um training both debt wise, but also the courses that we do have to attend for our C C T. So our vision for the survey which we're repeating after five years is to have it really pan specialty and also have it pan grade so that we are capturing both the fy ones and Fy two who want to have a career in surgery and the post CCT fellows who have just gone through the training pathway. Um It is for trainees in the United Kingdom and the Republic of Ireland. And this time, what we really wanted to do as well was having a more in depth understanding on what the non financial cost of training are for trainees. And the aim and the final vision is to have robust data which can then influence the future of our training. So what have we collected? We have a huge amount of data and we've really divided into the demographics. And this uh time we've added new things such as ethnicity and marital status. We want to look at people's work place. Um I want to know where they work. They're great. What region do they do any out of program? Are there any differences in their study budget? And we've also added like locum work, which makes a lot of everybody's work these days and want to know why people looking, we looked at the financial costs in looking at that, you have to look at medical school debt, how that has changed. What is your growth pay in your take home pay? How is that different between different countries? Um and what your training costs are on the non financial power, which you'll hear a lot about today. We are really divided into three parts, your physical health, your mental health, and your relationships and how surgical training affects you. So I'll go through some preliminary data. Now, starting with demographics. We've had um the great majority of people replying from England, England. At the moment, we've had 670 responses to the survey within two weeks. But we've also had representation from all the other um nations. But as you can see, we will need more people, not from England answering our survey. We've had the representation from people from different genders, female male represent the majority of our respondents, but we've also captured um the wider surgical community. So the age of our participants, as you can see is a standard curve with the majority of our participants being between the age of 30 and 35. And specialty wise, we've had responses from all specialties, especially general surgery and orthopaedic surgery. And we've had a good response from different rates with over 40% being higher surgical trainees and another 30% are core trainees. And as Leda is probably, um I talk quite sad was seeing how much the debt has increased now, for those respondents who are just starting their career where people now have thing around uh you know, 60,000 lbs debt upon graduation. Um And that has increased massively also compared to our previous survey where the average debt was 22,000 lbs. And um as I said, we looked at look and work. You can see what percentage of people does extra work on top of their very hard rotations. And it is actually around 60% of people. And you would think the main reason they do it is educational, but actually the great majority of people do it because they need more money. I'll now move on to talk about the non financial cost of training. And you know, we looked at things that really matter to people settling in a permanent home and you will not be surprised to know that 80% of respondents said, um actually surgical training has impacted their ability to settle in a permanent home. We looked at physical health and um it is very striking to see that the majority of people, around 90% of people have said that surgery has had an impact on their physical health. So 20% of trainee had to seek non pharmacological help with 10% having to then seek pharmacological help. And one in five of us have had to take time off because of the impact of surgery on their physical health. And we were very grateful to around 100 and 50 trainees who were able to then elaborate on this. Um And the main themes to recur was, you know, we don't have sunlight in the hospital. The food is not good. We're always tired were dehydrated. We have back pain, we can't exercise because we're so busy at work. And you know, it is quite hard read. We looked at the mental health as well. And again, um, you know, one in three of us has had to seek non pharmacological help for their mental health. With one in 10 having to seek pharmacological health. And one in three have had to take time off work because of the impact of surgery on their mental health. And the main things, again, we're looking at stress burnout and we're also looking at the problems that people face. Um being a parent and having to sit the very stressful mrcs and how there is no support for that. The sense of being overwhelmed. And something that made me really sad was reading about a trainee saying, you know, living away from my family does make me sad. And why do we accept that? 90% of respondents report that surgical training has had an impact with the relationship with their family or friends. And again, 80% says that it has had an impact on the romantic relationship. And as you know, a lot of us do miss important family event and 60% of miss more than five important family event due to clinical work. But I think even more importantly, 66% of people have missed family occasions due to non clinical work that is necessary for their progression. So that's in their free time. And you know, all the further comments that we've had again, very grateful for the 120 people who've put amazing effort in writing this paragraph were related to the fact that our training sometimes is behind our times and reading someone say, you know, the system seems to be set up for a 19 fifties husband to have a career in surgery with a wife to stay at home and sort out the house. Um, or thinking, you know, saying, you know, I think we need to rethink surgical training. I'm very hard was to read about all the senior trainees saying I don't think I can tell my juniors that they should pursue a career in surgery and I'm not really sure I would go through it again. Um So I've been through something that is, I found quite sad and very eye opening. Um, but I think we have, um, we have to be optimistic and we have the thing, things in our hands. Um This is preliminary data will do a very in depth analysis so that we can show concrete data and the voice of all trainees. We will publish our result and disseminated widely to stakeholders. And this is just the sort of our work we will continue the academic work looking at trainees well being. And I think there will be so much data that we can all generate new ideas. I want to say, thank you. This is not my work. This is the work of the cost working group, It is a big group and they've worked incredibly hard, all of them and I am very grateful. Um I hope I've not depressed you too much, but we can make a difference and we start by feeling this survey so that everyone's opinion and we know about all of your experiences and we can share them widely. Thank you very much. That was fantastic. Thank you. I think the large number of respondents in such a time short period says it all really. Um We have time for maybe one question from the crowd. If anyone has a question. Okay. Thanks very much for, for that. Um My question is have other specialties in terms of medicine opting, guiding psychiatrist sector. Have they done a similar sort of work? And is there any role to look and see whether how much of an outlier surgery is on either the financial or these sort of other difficulties point of view? Yeah, there there has been work. Um A lot of the work has not been done in the UK, but there has been work done mostly obscene gain and general practice. Um, as well. I can tell you, for example, for surgery, the previous survey run by asset is the only thing I could find in the literature related to kind of the surgical population but mostly has been obscene guinea in GP. Okay. Thank you. Uh So next.