The Royal Colleges Presidents Address | Prof. Neil Mortensen, Prof. Rowan Parks, Prof. Deborah McNamara (VP), Mr Mike McKirdy
Summary
This 2023 ASiT conference is a great opportunity for medical professionals to reconnect, share experiences, learn from one another, and be inspired as they collectively strive to push the boundaries of medical practice. With numerous esteemed panel members, including esteemed surgeons, innovators, and educators, the conference will discuss the latest advances in surgical technique, explore approaches to patient care, and discuss the future of the medical profession. Through financial and non-financial support, this conference can allow attendees to take a step forward in their career and excel in the medical field.
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Learning objectives
Learning Objectives:
- Identify strategies for successfully navigating the challenges of the pandemic and post-pandemic era for surgical trainees.
- Understand the importance of embracing opportunities to connect and inspire colleagues within the medical profession.
- Identify new advances in surgical techniques and approaches to patient care.
- Understand the finances and costs associated with delivering surgical training events.
- Appreciate the importance of resilience, collaboration, and innovation in the medical profession.
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The following transcript was generated automatically from the content and has not been checked or corrected manually.
Good morning, everyone. It is my great pleasure as asset Presidente to welcome you all to your 2023 conference here in the beautiful city of Liverpool. As I going Presidente, I'm honored to have the opportunity to address you all ahead of what is set to be a fantastic two days of conference. This year's conference theme is reconnect and inspire and it could not be more timely or relevant. Over the past two years, the pandemic and post pandemic era has caused unprecedented challenges to surgical training, testing our resilience and the capacity to adapt. But in the face of these challenges, we have also seen remarkable examples of collaboration, innovation and courage. Our conference is an opportunity for us as a surgical family to reconnect with one another, to share our experiences and to learn from one another. It is a chance to celebrate our collective achievements, to recognize those challenges to do, lie ahead and to inspire one another to meet those challenges head on. Over the next few days, we're going to hear from some of the most innovative and inspiring minds in the medical profession. We will learn about the latest advances in surgical technique, discuss new approaches to patient care and we will explore the future of our profession in a rapidly changing world. But the conference is not just about learning and networking. It is about rekindling the pash in and dedication that brought all of us to this profession in the first place. It is about reminding ourselves of the importance of our work and the difference that we make to the lives of our patient's. I would like to take this opportunity to thank the asset team for their tireless efforts in organizing our event as well as our generous sponsors and industry partners. And of course, I would like to thank you the delegates for your commitment to our profession and your participation in all activities over the next two days, let us embrace this opportunity to reconnect and inspire one another and to continue pushing the boundaries of what is possible in the medical profession. I wish you all both a productive and inspiring two days. Thank you very much. It is now my honor to introduce to conference, our incoming presidente, Mr Son of a share of you. Thank you Martin and welcome everybody. It is my pleasure to introduce the first session of the day, the Royal College president's question answer session and we are blessed to have an esteemed panel. I'd like to introduce then one in turn first, we have Mr Mike mccurdy graduated from the University of Glasgow Medical School. In 1985. After the surgical training in West of Scotland, London, Manchester was appointed a consultant surgeon at the Royal Alexandra Hospital. Paisley in 1997. Mr mccurdy was previously professional advisor to the Scottish government's global Citizen program, a pioneer of development of breast cancer services in Clyde area of where Scotland and National clinical lead for breast services. His previous formal college roles include Vicepresidente Surgical Director of Global Health and Chair of the Hope Foundation. Please give him a warm welcome. Our next catalyst, Professor Rohan Parks is Presidente of RCs Edinburgh, General Secretary of IHP, be a treasure of E A H P B A and has clinical research, clinical research interest in HPB surgery. He has received numerous awards and honorary fellowships has published significant work and has significant experience in medical education including roles in the University of Edinburgh Medical School and NHS Education for Scotland. Please give him a warm welcome. Thank you. Our next guest, Professor Neil Mortensen is a professor of colorectal surgery in the University of Oxford Medical School and has been on the staff of Oxford University Hospitals since 1987 where he is currently honorary consultant colorectal surgeon. He is Fellow of Green Templeton College. He is since his appointment in Oxford. He has campaigned for the recognition of colorectal surgery as a specialty and created the present department. He became a member of the Council of Royal College of Surgeons of England in 2013 and a member of the trustee board. In 2016, into 7 2017, he was appointed vice president and in 2020 Presidente, please welcome into the stage and our next guest, Professor Deborah mcnamara is a consultant generals and colorectal surgeon and clinical professor in surgery at the Royal College of Surgeons in Ireland. She founded Better Beaumont Quality Improvement Learning Collaborative in 2014 to support hospital based improvement activities. Please welcome her and our last guest by no means the lest our immediate past Presidente Misla lot, a key word Brown, please welcome home. So as part of this presidential Q and A session, we welcome our members and the audience here to draw questions of which I'm sure they'll be keen to engage with. So please take this opportunity to use the medal chat up there on the screen. You've got the QR codes available to you and send anything through that you wish to communicate directly in the interim period. I'll have it over to Martin and the team to see where the questions will start. Three. So President's the past number of years, as I said, an opening speech to conference have been challenging. But in the past number of months, we've seen a huge resurgence and energy in making things better. And that's through innovation and surgical training as college president's. What are your priorities in the next 12 to 24 months? And what is your outlook as a college in terms of supporting trainees during this time. And I'll go to Professor mcnamara first. Um, so thanks for the question. I suppose we're keen to make sure that surgery remains a profession that, that people can enjoy, that they can have a wonderful career in. Um Our priority really is around trying to continue to support our trainees with educational opportunities to ensure that our trainees are able to access all of the latest technology and their training through our simulation facilities. Um and really to try and just build a profession that supports everyone. Blankie, Professor Matanza, good morning, everybody. So I've been the pandemic presidente and actually I deem it in July and I have to say it's been a pretty challenging time. I just want to say right in the beginning, it's been an absolute pleasure to work with the leaders of asset over the last two or three years in such difficult and tricky circumstances. So I'm uh in the business of trying to uh recover surgery. You've heard about us talking about surgical hubs, more surgical capacity for the first time in 20 years in the country. It may not seem a lot when you hear about the hubs and how many beds and so on. But I tell you what, it's a lot better than nothing and of course that we will give all of you more opportunities to have educational and training in the workplace, in surgery where you want to be, you want to be getting your hands on, you want to be doing stuff. That's the joy of surgery. So I've been trying really hard to make that happen. Professor Parks. Yeah, thanks. Uh Martin. Great to be here. Great to see so many people in the energy, uh both last night yesterday and today. And, yeah, I guess it has, it's, needless said been a really tough couple of years. Um but the strap line for, for my presidency has been that phrase making it better. That's, that's what we want to do as a college. It's my ambition that we make it better, make it better for the medical students, looking at a career in medicine and particularly in surgery, making it better for the trainees, you've had to, you know, come through that pandemic, the loss of training opportunities. So advocating on your behalf that you know, as clinical recovery occurs, there will be training recovery as well, but also making it better for those and established posts for those in our S A S grades and for those at the end of their career so that we make it better for those who are coming to the end of uh of a career and that we don't lose them. So, retention is a big thing because we need a workforce. So making it better has been our strap line and I guess will be in the months and years ahead. Thanks Mr mccurdy. Thanks Martin. I think the first thing to say is this has been a, we use the word challenging, challenging time. It's been an awful time in the last three years. And if we think a surgical training career is maybe 10, 12, 14, 15 years in total for three years of your training time to be impacted by the COVID pandemic is really challenging and really difficult and really awful for all of you. I think as Neil said, the recovery and road was saying there also the recovery of the surgical service in the NHS is really important to your training. So that's something that all the colleges are working on with UK government that devolved administrations. How can we get more surgery undertaken? Because that's good for your training. Also good for the service in supporting you as trainees Martin. To your question. I think Debbie is right. We need to make sure the training opportunities. Are there educationally for you using simulation and so on and we're all working on that um in all four colleges. But I think another thing that needs to be remembered is is support for you as individuals trying to navigate all of this, your well being, making sure that the environment that you working with your trainers as a supportive one in which you can learn and flourish. And that's a really important role I think for colleges to encourage a an environment in this very difficult time, be difficult for you as training is difficult for everybody. Work in the NHS are the health service in, in Ireland, but we need to get some kind of positive framing and that we can let you flourish. As young people who want to be surgeons. Thank you. Kind of taking some of those responses. I think one thing, it's maybe the elephant in the room though, against all of this is the cost of surgical training in the present climate. And I think that is a real issue that we hear a lot. And as you will know, we are planning to later this weekend release some of the results of our cost of surgical training survey. And I know that this year the J C S T fee has been frozen as part of the colleges initiative to support trainees. What other ways do you see as college president's that financially and non financially, you can, you can offer as well as the educational aspects of being a surgical training. Ok. Cost. Um As you say, the J C S T fee has been frozen, not for the first time, I think for now, 67 years continuously. So we are all very conscious of cost. Um All of our colleges are organizations which are not funded by UK government in any way, shape or form. So as you know, in order to create facilities to have people employed by the colleges to do all that we do has a cost um and that's borne by fellows and members of many of you are fellows and members of the college and you know that and you pay your subscriptions to us. There are costs in delivering training events. You know, there's a cost to delivering this event this weekend and you can't do that without people paying fees and without support from perhaps industry and others. So it's a cost to doing anything. We need to keep those costs as minimal as they can be particularly and mindful of trainees, other financial challenges. I think we were probably all lucky enough to go through a university system in which we didn't have to pay fees. You've come through a very different system and, and started your careers indebted um financially. So I think we're very conscious of that and looking to keep fees for anything that we do minimal and put the more of the burden on the wider age group who are fellows and members of colleges rather than on the younger end of that spectrum. Thank you, go to Professor mcnamara. So I suppose our system in the Republic of Ireland, slightly different and that we don't have the dina re system. So we have a responsibility in training as well as the the college function. So it's slightly different. And as a result of that, we receive some subsidy for our trainees to support our trainees with their education and they're mandatory courses. So that's something we're really conscious of trying to continue. We work very hard to maintain the relationships with the health service to enable that to continue. But cost is always at the top of our mom. And I suppose any time we're arranging something, you know, we're always thinking, does this justify what the person is going to have to put out in order for this event to happen? When were saying of course, is mandatory, cost is always at the top of the program in terms of when we talk about that and we try and figure out what's the benefit to the trainee of doing this course? Is it essential? Is it absolutely mandatory? But obviously we have to maintain the standards, we have to comply with the same standards as, as pertain here in the UK. Thank you. Uh Professor Martensson. Yeah, Martin, as you know, we've been waiting for your report for a while. I'm not in any way suggesting it's taking too long. No, seriously. We would like to be able to lobby on your behalf. I quite realize exactly what everybody's saying about the cost of training and that has repercussions across across your personal lives, uh and your family lives. Um and in terms of actually surviving through training. So we completely understand how tough it is. Once we have that information, we will, we promise lobby on your behalf uh in the corridors of power in medicine and surgery as far as we possibly can. Uh And nudge persuade influence as much as we can on your behalf. Um, I don't think our political masters understand the cost of training in, in medicine and surgery. And I think part of our duty will be to explain to them exactly how much it does cost at the college level. You know, we could engage in an arms race on the, on, on, on the panel here and say, you know, our, our, our offer is better than yours. And so, and I don't want to engage in that. I think in fact, it's really rather sad. There are so many colleges we should if I had my wish, have one surgical college representing everybody in the in, in the UK, clearly, Ireland's a separate jurisdiction, but we are trying really hard to work together. One of the things I've noted uh in Manchester and Liverpool is the pain that many, many services are going through to try and reconstruct to try and uh remake their services um and not duplicate and not compete to make the very, very best off of both trainees clearly and the staff and most importantly, the patient's. So I hope we've learned from COVID that we need to collaborate. And this one area is really important. You are the future of surgery. We have to engage in what it costs to train and we will lobby on your behalf. I think on, on the point of collaboration, I think the past number of months of collaboration has been really, really at the forefront of both trainees and colleges. And from our perspective, we want to say thank you for the colleges representing those members in England in relation to the upcoming Industrial Axion. I think that's going to be important. But finally, Professor Parks on that question as well from the Royal College Surgeons. Thanks Mark. I think we are very much all on the same page in this. We all absolutely appreciate the the cost of training. And I think for those crafts specialties of which surgery is a big part. I think it's well known that the costs are generally a bit higher because of the skills element to it. So I think what we are trying to do is to advocate for additional resource uh from the higher powers that be. But I think there's other initiatives that we can do, you know, we can partner with, with industry. Um I think we're in an era now where that's very much going to be part and parcel of how we deliver some of the training elements, elements. So in in partnership with uh with industry and then all all of our colleges, you know, try and return some of the funding for opportunities. Be they research, be they traveling fellowships, uh be the bursaries for, for all sorts of activities. So we're all trying to, to deal with this. And I think we absolutely understand the concern. Uh and as Mike say, you know, it's, it is starting from a point that even coming out of medical school, there's, you know, debt already for you guys to have to manage. And that's uh you know, a real challenge and it's very real, particularly in the economic climate we're in now. So as colleges were trying to do what we can to keep course fees as low as possible to keep the J CSTV static as low as possible. Uh And trying to play our part in a, in a much bigger system. Thank you. I'm going to pass over to my colleague low that but I'm sure many of you in the audience have lots of questions for the President's. If you want to ask a question, do we raise your hand? And one of our team will bring a mic to and we will now go through some of the questions that we're getting through the chat. Uh Hi. So yeah, there's a couple of themes coming through on the chat talking about bottlenecks. So what are your views and thoughts on how we can improve medical student numbers but also improve the bottleneck when they get to see ST and high surgical training because we know we need to improve, increase the number of doctors and surgeons all over the country. But there's also uh students, trainees who just can't get a job. So how do we match those two things start with Mr mccurdy? So I think on medical student numbers. First of all, I think we're all agreed that there aren't enough doctors per capita in the UK. And they're now, is some traction on that right across the UK. Scottish Welsh government's northern Ireland Assembly. Everybody is on the same page for once in my career. Over the last 40 years, there doesn't seem to be so much disagreement about that concept from somebody starting medical school. This year, we had an extra 100 students in Scotland started last October. It will be five years before there. An F I wanna be seven years before the coming in to see. ST so as we increase these numbers, we at least have some lead time looking ahead to where we go with training numbers, but obviously they have to be expanded. Also, the NHS has never in my experience ever done workforce planning in any way that was realistic. It just has never happened and that needs to happen. Now, Lola if we're going to really see the expansion in training numbers in the appropriate way that we will need more consultants for the future. Um And so we need to get to work on that right across all medical and surgical specialties in surgery. I think it's pretty clear we're going to need more surgeons for the future. We will perhaps this morning talk about um report from English Colleges, Nuffield Trust about Parenthood in surgery and less than full time training and so on people who go through less than full time training as trainees, understandably quite often continuing part of their consultant career in less than full time training. So we need to take that into account and the arithmetic that we were going to need a bigger head count. And we are lobbying really hard for increased medical student numbers and increased training places. Um And I can't give you an answer that's going to fix it for this year for people looking for ST posts. But we are looking to increase the overall envelope and make sure that those jobs are in the right parts of the country to take up all of the people who want to be coming into the surgical specialties. Yeah, very similar. Um There has been at last a recognition that uh we need more numbers uh and that has to be generated coming through the medical schools. So those numbers are going now into the system, that is a decision that has been made across the four countries. Uh And, and so we will see the benefit of that that's already been matched by some expansion in foundation places and already some expansion in the specialty, training grades and surgery has been included in that. I think that will just need to continue for all the reasons Mike has mentioned in terms of less than full time training and people taking career grap stepping on stepping off of training, but also in consultant practice perhaps not working full time. So for all those reasons, we absolutely need the expansion. I think all four departments of health have recognized that they've listened to, to the colleges um advocating for that for many years and they're slowly responding. So I think we are at least seen a recognition and an acknowledgement that we, we need expansion in terms of bottlenecks. If you actually look at a lot of the data, the competition ratios aren't as severe as the perception that they may be. Um And you know, it's not a 1 to 1 match at each stage of training, going into court and going from court into specialty, but it's not much above that. And it's certainly not the, you know, figures of 10th people applying for every job that maybe was a decade or two ago or 20 people applying for every job. There is some attrition, there is also some tighter areas geographically and specially specific. But that fluctuates from year to year overall. If you look at the big picture, there will be opportunities for everybody if you're prepared to either wait an extra year or maybe change a slight location. Um And that's just the way the workforce pattern tends to work. But the bigger picture is we need expansion and we've been advocating for that. And I think we're seeing, I think that's kind of one of the difficulties of training is that you kind of you plan your life and you want to, you want to do this job in this place and you cannot plan everything around that. And it's a bit difficult having to think that you're not going to be able to continue to live in this place. You're not gonna be able to plan for where you're gonna be in three years time because you don't know, you're gonna, you're gonna have to wait around and that's just not, sometimes that's just not exactly what you want to be doing. And I guess we just need to get to the point where hopefully you can say I want to live here, I want to work here and then you do it. So, so, you know, you make a really good point. And actually, that was one of the big attractions for some people who had wanted to do, run through training to have that continuity. Uh And in Scotland, it was one of the regions where we heard that message from trainees and we kept it now that wasn't, you know, felt to be appropriate by everybody. Uh And therefore, you know, we have decoupling and you have another hurdle, you have another opportunity to move. It was actually one of the very positive things about a run through program. We are where we are now, but actually maybe in the future, what we should do is have a much more mixed model for those that want that stability, geographical and for family and support reasons. Once you get in your managed through that system, run through neurosurgery, do it. Um Maybe we should have some more opportunities like that. And yet for others there is absolutely. Um, they might have decided what career they want to do. Much more generic few years at the start of their training, core training to explore a different, you know, variety of posts and then decide what they want to do. So, you know, I think we need as much flexibility in the system but also try somehow to give that security and constant city, which for some people is a life choice that is a preference compared to a different way. So my, my and what I would advocate for is a mixed model where you have both options. Promotion for Tencent. Yeah, thank you. So we've been um colleges, Academy of Medical Royal College has been lobbying around the workforce issue for some time. Jeremy Hunt when he was chair of the Health and Social Care Committee was also on board and now he's in the Treasury. I think they have heard. Uh And as far as we know, NHS England is going to put out a workforce plan uh sometime towards the end of March, which will include increased medical student numbers and will include increased training places. So there is the political will, there is going to be the money to do it uh in terms of how that's then organized, we've got to help with that process. Um, I mean, you've touched on one of the, one of the issues around training particularly and our parents in surgery document and the latest, uh, Nuffield Trust um, piece that's been done with us points out to exactly what you're saying. It is very, very difficult. Uh, if you are a double professional couple or you have commitments in a particular region to be moved all around the country during your surgical training, it makes it just so difficult. And I think that's something uh we need to publicly lobby about two, but workforce were on the March. I'm really pleased. It sounds as though something is happening at last. Uh So I suppose in the Republic of Ireland, what's happening is we have had agreement from the government to fund more medical students. So that is definitely happening and they've actually put a challenge out to our medical schools to increase numbers. Um in my work with the National Clinical Program and surgery, which is our health services organizational system for surgery. We've, we've been working with the health service to develop a workforce plan for surgery. We're about 12 months into that work and we anticipate finishing it up over the next sort of coming year. It's really difficult work. It's very hard to model and the workforce needs based on such a long training system. It's not impossible, but no place does it perfectly. And I think there are a lot of lessons for us to learn because we, we do need to maintain choice for trainees. We do need to maintain the ability for trainees to change their mind and to try something and maybe not like it maybe want to move. So that flexibility has to be in any system. And I guess we're also conscious that as we expand training numbers, which we are actively doing, we want to make sure that the quantity doesn't go beyond the quality so that those posts are good posts that they're interesting posts where trainees can meet their milestones and where they can have a good work environment. Um So we are working on investing in surgical trainers because obviously without surgical trainers, it's really hard to have good quality surgical training. Uh and that's a key really and it has actually been an impediment to us and expanding workforce numbers for trainees because um in some hospitals, we don't have a sufficient number of surgical trainers to support the training numbers that we feel the hospital could support. Thank you very much for those answers. I think the conclusion there is that we've still got some work to go, but we're on our way. Um, shrimp. Do you have any questions from the floor? Absolutely. I mean, the I'm not quite sure I can see where the mikes are running around. So we have a room and Mike with Emily just here. So if you want to ask a question, anybody raise your hat. I'm in the middle of roadside. It's all right. But it should just work. Yes. Yes, I'm Mark. I'm one of the, uh, specialty general surgery training. So I just want to ask, obviously you mentioned about the fact that the competition ratios don't end up as, so they're sort of coming as 1 to 1 that points and things. But, um, really the core trainees or people applying for core training are now under increasing demands. The short listing criteria is steadily increasing every year. So I know of multiple people who are S H O s you've applied, who have not got uh number who have been excellent trainees and they need to have a C V better than me as especially training to get into a court surgical job. So if the competition issues out there, how do, how do we quantify that? How does that happen? So start with Mr mccurdy. So I don't know the numbers for what you're you're referring to. Their surgery has always been a competitive business and, and that is not changing. Um We as the colleges don't recruit to court surgical training. We all as professional organizations, colleges and asset and botha and others can contribute to the discussion's with the statutory education bodies who do recruit. Um It's difficult, it's difficult to take that argument and do anything else with it. Other than say, we need more places for people to come in because I don't think we would want to say that we want to diminish the quality of people coming into training. So if it's competitive, people will do more, they will have more on their CV. They will want to shine at that application stage. But the only way really to deal with that and that comes all the way through this workforce pipeline is to increase the number of places available. And the only way of doing that is for us all to lobby. As Neil was saying, Jeremy Hunt has accepted that in Scotland, we've had considerable success with the Scottish government in increasing medical student numbers and training places. So we all need to be lobbying on the same page. I don't think we can say that for this year, we'll just let everybody wants to be a co trainee start because as, as Debbie was saying, we also need to make sure that the places are proper training places. I don't want to do that. I can remember when things were different. But let me do that for a moment. I mean, you used to have S H O jobs and in hospitals up and down the country in which you were not being trained. And that was what happened before there was core training. So the whole system of modernizing medical careers we brought in 12, 14 years ago was to try and make this better and to make sure that you didn't end up in a dud S H o job somewhere, not being trained at all, but wanting to be a surgeon. So at least we have confidence that the product is right, that core training works and gives people experience. Maybe as Rohan was saying, run through will be better. We can argue and discuss that. But we, the only answer to the challenge you give is to increase the number of places. Yeah. You know, I agree entirely. It'd be nice if there were more jobs that for those that want to be in a particular, I but I can tell you that we haven't filled all our core surgical Dream Pro programs across the UK every year in the last few years, Northern Ireland hasn't filled Scotland hasn't filled the southwest of England there, there's still some gaps in the system. So, so part of this is geography as well as just pure numbers. Um and, and part of it is a lot of people at court are applying for multiple specialties. So the competition ratios appear very big and, and for the practicalities of it, there has to be some sort of short listing. So unfortunately, that means that big group that apply gets smaller, but then for the practical reasons um of of matching and, and going through recruitment process, not all the posts are sometimes filled because some of those people are applying for multiple specialties, be it radiology. Um Some of the physician lee specialties, all sorts of different career because they're undifferentiated, they're purely potential. So that's where it becomes really difficult and each year it will fluctuate and change a bit, but it's very geographically dependent. Uh And so some regions just about fill their court surgical programs every year, you go to London, mind you, it'll be way over subscribed. So it's, it's geographically related as well as just being at stage level. Be it entry to court or specialty training before we go to Professor Martensson and Professor mcmorrow, um Professor Barks Scotland is still running its I S T program and in many ways, it's viewed as kind of a really successful program and experience. Do you think when you mentioned there's been less numbers this year filled in Scotland? Do you think that's the climate that we're in or what would you comment on in terms of that? You know, it's, it's not felt, I think there was one post maybe not filled but, but it's still, you know, just shows that there's capacity. Uh and I ST I guess as a, as a term has we've moved on from that. It's, it's not just how we deliver training, but that was a real initiative that we all engaged in to try and make it better for training. And we are all wanting to do that. I think one of the advantages in Scotland was the colleges and the statutory body worked collaboratively together and convinced Scottish government to give us some additional resource which we then invested in simulation activities and we had a real champion to sort of lead that charge and sort of create a very bespoke program. Got buy in from all the trainers, the really important part that Debbie talked about. We needed to get buy in from the trainers and the health boards to deliver it. But, you know, we need to keep improving. That wasn't just a one off thing. So we all need to be engaged. The colleges need to be involved. We need to engage with the Dean Aries and, and you know, the local trusts in hospital and settings and boards to, you know, look at maximizing training opportunities using simulation where we can. So I guess yes, it was an incentive to do more to make it better to improve uh sort courter training. But, but we can't just rest are we need to keep doing more and to keep pressing forward? Thanks. So just to say south of the border, it didn't work. Part of the reason it didn't work was that it wasn't funded. So I think everybody thought it was a great idea. Health education England were deeply disappointed in us as the surgical leadership. Uh They didn't think that we'd used the investment in uh arranging the pro uh the program well enough. Um but we repeatedly said to them, well, it needed to be funded properly and that's why it fell on its face, which is a great shame. However, I think, uh as everybody said here on the panel times have moved on and I think uh there needs to be a range of provision, there need to be uh run through post for those who want them. They need to be that flexibility that some people like in being able to uh not necessarily decide immediately where they're going to go, what specialty they're going to be in and so on. So I think there needs to be a multitude of provisions to make the whole business of getting into surgery more attractive. Thanks. Um So your, your question was a bit about the difference from year to year and how you're more junior trainees were having to meet a higher standard than you yourself met. And I suppose we're responsible for, for recruitment to court on higher training in Ireland. And I can only reassure you that we spend a really very significant number of hours trying to define the criteria, trying to measure the criteria. Um There's two angles to it really, I suppose, firstly, it's really important that each person who applies is fairly assessed and we've worked hard to make that as objective as possible. Um And in our work to try and address issues around diversity and equality and inclusion, we've really focused a lot on objective criteria. Now, they can feel like milestones to someone who's applying and it can feel like that's, you know, yet another hurdle that's being put in their way. Um But we're trying to eliminate subjectivity from surgical decision making in terms of who gets into surgery, how they advance in surgery so that everyone's on an equal playing field. Um We're, we do our best to communicate that with applicants by putting it on the website. Um And we, we show all of our data on people who have been successful who's been unsuccessful. We publish all the demographics openly. So um it does sometimes feel like a hurdle to be, to be overcome, but it's really hard when you have a good number of people interested in doing surgery. And as you say, when you work with them as doctors day today, you know, they're fantastic people and they probably be great surgeons. But unfortunately, in an objective recruitment process, we have to find a way to prove that and in a system where we rely excessively on someone's judgment of what makes a great surgeon versus objective measures of what makes a great surgeon. Um It can be very tricky and it can bring up other challenges. So it's a really tough area to get right. We look at it every year, we revise what we do every year, we try to keep trainees informed. But, you know, I I totally take your point. It's very challenging and it does change from year to year. You mentioned demographics. There, there's quite a few kind of themes in the, in the chat about I MGS. We recently recently had um the data released about racial, racial disparities and entertainment. So what are the colleges trying to do to improve outcomes for I MGS and also for different races and the differential attainment there? So? Well, sorry, you're going that with. Okay, thank you very much. So, uh as you all know, we um published the Candy report in early 2021 the ripples have flown out from that throughout the surgical profession, throughout all the surgical specialties. Um It's not good enough just to say we have to do so. Uh in our college, we have both an in house group and the professional group looking at how we increase and promote in the long term, either our diversity. I think we recognize that um international medical graduates are going to be an increasing proportion of our workforce and that we have to have a better deal for them. Um I think that many of them feel when they first arrive unwelcomed, uh they find uh the regulatory arrangements incredibly confusing, those need to be signed, posted better. Uh And then I think we need to be as a surgical profession as the college is much more welcoming, finding ways to encourage them to both be part of our colleges and be part of the surgical community. There are in the background, discussion's going on around arrangements for international medical graduates um to get into our system through alternatives to the Caesar route, for example, uh there's a lot of change, a lot of discussion um going on in the background. Some may come to fruition, some may not. Um but without seeing everybody else's thunder in a word, uh It's something we have to really do something about uh and, and have some practical programs to be welcoming Mr mccarty. So I, I think I take it in, in two parts, I think if we think about inclusivity and our colleges and across the surgical profession and the, the challenge to that is the record which the UK made data makes very clear that there is differential attainment in all specialties in all parts of the country um right across the UK and Northern Ireland. So we need to own that problem and Neil reference the Kennedy report into Royal College Services of England, which has been great reading for the rest of us because we all need to be as institutions, you and asset. All organizations need to be thinking about our inclusivity. And the big challenge around differential attainment has been that the General Medical Council has asked each college all 24 in the UK and Ireland to come up with a plan to address differential attainment. We handed those plans in the 30th September and that work is underway now uh through the Academy of Medical Royal Colleges, working with the G M C and the statue educating bodies. So there is a big um Dr to make the medical profession, not just surgery, a fairer more inclusive place. So that's one aspect I think of the question you're asking and that's what we all need to be engaged in on international medical graduates. Um, empty coming into the UK with a medical degree. We'll find a pretty confused, seen in front of them. The NHS is pretty unique in the, in the world is a system. It's very difficult to navigate that. I always think of putting yourself in a position of going to any new place anywhere and just trying to get the car higher than get on the road and go in your holidays is challenging, never mind coming and working. So we need to understand that that's a big challenge. We need to do good induction and all of our colleges, I'm sure involved in that process for our specialties. But the NHS needs to take a responsibility as employers of these international medical graduates. This is new staff coming into our system, whether a high level or brand new, just starting off graduates needs to be good induction, good explanation of the system and support. And that really means support for those not in training grades often initially because it's relatively rare for international medical graduates to come in straight to ST jobs are core training jobs. So it's often about local employed doctors and those in SCS jobs and all four colleges are working collaboratively on improving a lot of that particular group of doctors. So it's work challenging work which we need to do, which we just need to do. Honestly, I'm saying that mistakes have been made in the past in the situation as it currently is, is not good enough. So we can all be involved in improving that. Yeah, you know, I think as others have said, this is a whole system issue. It's not just the colleges, we have a domain. So for example, those I N G s that are coming into in under each of our individual college sponsorship type schemes, you know, we very much can do something because we know who these people are, we take an interest in them. So for our own coming in through that scene, you know, we have an induction, we have mentoring, we have support, we have ongoing contact with them in the much wider system. As Michael says, some of those are coming in as locally employed doctors. So the only people who really know who they are going to be the employers, there's others coming in now through national recruitment who are going to be under the Dean Ary uh and static education system. But but we can't say well then that's for them to deal with. This is a whole system thing. Uh And as you know, as Michael said, we are trying to do things in terms of educational provision, sign, posting, support and networking but but also it has to be done at a local level by the employers. And I think there's a recognition there and there are various initiatives and things being done but it's not consistent. Uh and that's one of the issues, the other area of differential attainment, you know, this is such a wide topic but differential attainment. Well, what's that in its in art piece? And G M C have just published very recently there, progression data and there's differential attainment there uh and examinations. Uh and so assessments which colleges do have uh an interesting and, and as you've heard, you know, we, we have put in some feedback to the G M C about what we're doing. But it's a whole system thing but it involves trainee associations as well as colleges, specialty associations, employers, statue education bodies, the scenery. So, so it is a whole system thing. I think it's at least now much more transparent and open and people are talking about it, the data is out there and very evident. So we all need to be working collaboratively and, and thinking of these issues and trying to think of some of the solutions or things that we can all impact on. And I think at least those conversations are happening. Thank you. Perfect. Um So I won't repeat what everyone has said. There is a problem that needs to be fixed and I think we all acknowledge that and it's, it's about sequentially doing the work that needs to happen and understanding it. Um I suppose what, what we've done in our CSI are past Presidente professor on mcconnell, really made this a very key priority during his tenure as Presidente. And we had a short life working group. And for the first time, actually, we have some data and I think that's really a key point in, in terms of us being able to address the issue. So we're into the last five minutes of our Q and A uh very, very grateful for the President's for your contributions this time last year. Uh In Aberdeen, we had live 50 faces of surgery episode with the president's. Uh I know this was a shock to Professor Parks. He and Mr mccurdy, you were told just the same on the on stage. The theme of our conference this year is reconnect and inspire. And for many people, this is the only opportunity in the year where we get to speak to the senior leaders of the colleges in less than two minutes. Each, what words of wisdom, but also inspiration drove you to pursue surgery. And what advice can you give the delegates for the rest of their careers? But also over the weekend, I'll start with Professor mcnamara. Uh um So what, what drove me to do surgery? Well, I think it's all about the instant gratification, isn't it? There's nothing better than, you know, getting up in the morning going and completing a whole episode of care. Before you get home. Um, and that was definitely a huge appeal for me. The technical craft of surgery I think is something, um, theaters, my happy place. And I'm sure for lots of people in the audience, you know, there's lots of parts of your week which aren't the great times that they could be, but they just can't get you when you're in theater. So, I think for me that was a huge inspiration. And I guess, um that, that's why I guess trying to build capacity for elective surgery so that future surgeons can train is something that I'm utterly committed to because, you know, surgeons want to be operating and smart CEO is no, that surgeons who are operating don't cause trouble. So they want them to be operating too good advice. Professor Martensson. Absolutely brilliant career to be in, wouldn't have wanted to be in anything else. Um I think there are moments both in your own personal career in the national life of the surgical community where it gets really tough and I think these are those tough times right now, but I do think it's worth the price. I, I would say do stick in there. And I think as we've shown our joint statement around the industrial Axion, all the colleges, all the specialist associations, all the trainee associations, all signing together. It does show we have your back and we do want you to stay in the profession because um the future of surgery is here in this room. Professor Parks. Yeah. What was my inspiration? It was rule models. Um, and I guess that's what got me into surgery and I still look at those people and, you know, when I started out I never thought I'd be sharing a stage with you Martin and being at the, you know, the annual conferences type of thing. It's, there's just so many, um, enjoyable aspects to a career in surgery. Yes. The, the clinical side of it, the friends you meet the people, you meet the opportunities, you have the variety of it and you know, some will go down in academic roots, others will go down in education route, others will go down in management roots. There, there's just so many different ways that you can build something that is for you, but it's often based on those role models that you have. Uh, and so I encourage you guys um, to, to look at those role models and just be one step behind them all the time. But also think how your role models for the next generation coming, be they the medical students or the foundation doctors. You know, it's, it's, you're responsible as much as ours to be encouraging them into what you're doing. And in a career, if I was asked to do it again. Absolutely. I would do it again. It is the most fantastic career I could ever have thought of. I wouldn't do anything different? Thank you. Last word, Mr mccurdy. Well, hopefully we've inspired you from what we've just said. I think roads talk about us being you being role models, all of us trying to be role models and being inspired by people you've met in your career. Neal say, you know, this is the best career. And as Debbie Rightly said, I think we need to own up to that surgical instant gratification of doing something well by and large, we all became doctors because we wanted to do something for our fellow human beings. We wanted to be with them at a time of need and somehow or other help them in their lives to be a surgeon and take your assets logo, take a scalpel sharp knife and put it into a fellow human being and to be robust enough to take on that responsibility for manipulating their tissues to try and deal with their disease. That takes great courage. And I hope we can inspire to have the courage to continue to train as surgeons and the courage to be good surgeons for the next 30 or 40 years is a great way to spend your life. Thank you. We're gonna give you a round of applause. Thank you so much to our president's of the. So that closes our Q and A session. I'm going to hand over to our incoming Presidente Mr uh Chevy, who's going to introduce our next speaker. Thank you very much.