This is it folks! This is what we have been building to for the last 6 months! All the uppercuts, all the low blows, all of the urine extracted from orthopaedics 🦴 and all the shade thrown at neurosurgery 🧠 all culminate in this…

We are rejoined by listeners 🎧 , contributors 🗣️ and now pundits 🎙️ Michael Ahn (Health Education West Midlands) and Dan Lazenby (Health Education North West) as we comment on the whole of last season, and what a season it’s been!

We discuss:

• Capitalism at its worst 💸
• We won’t get cancelled will we?! 🚫
• Low key fans in high places 🧐 (proof down below)
• Acolytes of the knife joining in🤰👁️
• The best, best thing about surgery 🔪
• Core memories 💩
• Pinky / ye olde index haemostasis 🤙
• The best, worst thing about surgery 🥂
• Disappointing Asian parents 🫠
• Everyone gets a bit of love…except orthopaedics…because we don’t wanna admit that we need them… 😅
• The phantoms and apparitions that are cardiothoracics and neurosurgery🫀
• The winner 🏅 and loser of this season (with a little help from ChatGPT) 🤖

But remember folks…the real winners are the friends we made along the way! 🤝

-Go forth my son and cast thy pod! (the deanery’s unofficial endorsement of our activities).

https://imgur.com/a/5yWG5FD

-You just can't compete with him.... so don't: https://en.wikipedia.org/wiki/Jonny_Kim

-We're family here https://www.ted.com/talks/gloria_chan_packer_work_is_not_your_family_jan_2022?subtitle=en

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This season, we’ve been sat on the sidelines, taking in the action and providing commentary on the action like a Jim Ross, Jerry ‘the King’ Lawler duo (and thus the origin of the title of this episode)…

Anyways, later than advertised (as we grapple with Black Wednesday, new hospitals, new firms, kids, m0ar inductions and the joys of mandatory training), we are rolling up our sleeves and getting stuck into the questions we set for the others and we talk about: the best and worst things about training, what we wish we knew before starting, who we admire, who we’d cheat with and who we could lay the smack down on…

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This time it's personal: today its the turn of vascular, and Assad has roped in a formidable tag-team: Stacie Hodge (who is legitimately solid) and Mo Elkawafi (both Health Education North West) are in the vascular corner. Are vascular just angry psychopaths? Do they just direct all their wrath from blocked bypasses and failed operations at everyone else? What about those IVDUs? We chat about the good bits, the bad bits, and the bits that get thrown in the amputation bin. What do they wish they knew before starting? What are the biggest misconceptions, and finally, who could they take in a fight? Probably anyone if you take an arteriotomy knife to the right spot....

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Today we welcome plastics into the fray, and we're joined by Dan Lazenby and Henry de Berker (Health Education North West). We try and get to the bottom of what makes plastics plastics: are they biding their time to make a fortune in private practice? Are they low-key obsessive compulsive about the things that the rest of us don't care about? Is this an inherent or learned trait? We've heard they're a flamboyant bunch, but are the rumours true?! Do they in fact possess surgical superpowers? We delve into this and more, as we aim to scratch beneath the surface. As for who they could beat in a scrap, they maintain they're lovers not fighters, but their strategy is credible and they're not afraid of taking on multiple specialties!

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Cock rings and banjo strings.... This episode has it all!

Probably our most NSFW episode to date, but what were you expecting from urologists?!

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Happy first birthday to us! 🥳 And as a little birthday present to you all, we are releasing probably the funniest episode(s) we've done. This episode heralds the entrance of urology into the arena, and we're joined by some friends across the country! Today we have our guests formed entirely from listeners; Mahmoud Nosseir and Michael Ahn (Health Education West Midlands) are gonna talk to us about the highs and lows of urology, the best bits, the worst bits, and the dirty bits. Very quickly we descend into puerile penile jokes, and the humour goes straight into the toilet...

And, as urologists are all too aware of, the stories are the only thing flowing freely! We talk about the things they wish they'd known, which specialty they could cheat on their own with, and who they could take in a fight? To be honest, with these stories, they could take everyone; the rest of us would be collapsed in a heap, incapacitated with laughter...

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Today is the day we welcome orthopaedics into the ring! And just like John Cena, they're hench, well-dressed and look good behind the camera. Plus, you can't see them (out of hours anyway!)

We're joined by orthopods extraordinaire (and returning guest) Rich Unsworth and Azhar Din (Health Education North West) who started out from the same humble beginnings but fought tooth and nail (pun intended) to get into specialty training, and make it through to the end.

We find out from them about the best and worst things in orthopaedics and if orthopods truly misunderstood? We also discuss the things they wish knew before starting, like the grind, the bottlenecking and the fellowships. Lastly we find out how they fancy their chances against everyone else in a hypothetical brawl...all that limb traction gotta come in handy some time right?!

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Loud, angry, trash-talking, on the warpath. Not to be messed with. That’s how many have described Steve Austin (the namesake of this episode) but it also seemed quite fitting for general surgery.

‘And that’s the bottom line, cuz Stone Cold said so!’

We’re joined by Caitlin Jordan and Adeeb Rehman (Health Education North West- Mersey) as we talk about: the best bits of general surgery; the worst bits; the things they wish they knew before, and crucially for this Smackdown….who they could take in a fight…

———————————————

RCS England - General Surgery https://www.rcseng.ac.uk/careers-in-surgery/trainees/foundation-and-core-trainees/surgical-specialties/general-surgery/

BMJ - The complete guide to becoming a general surgeon

https://www.bmj.com/careers/article/the-complete-guide-to-becoming-a-general-surgeon-

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We're back, and this season we're bringing the smackdown!

We're drafting our friends, colleagues and listeners to tell us why they love the job they do, and why it's the best bit of surgery.

We're pitting all the different specialties against each other in a sort of Royal Rumble free-for-all to find out who reigns supreme.

Which surgical specialty is the most respected? What specialty do people secretly wish they did? Which specialty could take all the others in a fight?

And... like wrestling, it's scripted, it's theatrical, it's here mostly for entertainment. Also, just like John Cena, you can't see us.

Surgical hunger games: https://www.reddit.com/r/doctorsUK/s/dnjQE7VjwH

Plastics getting stabby: https://www.dailymail.co.uk/news/article-9158927/Top-plastic-surgeon-56-charged-attempting-murder-ex-colleague-surgeon-65.html

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This episode brings this season to a close...just like its namesake. Get it?! Ok we'll see ourselves out.

22 episodes, 44 weeks, and over a year worth of recording to get our first season done. What a slog it’s been! But an enjoyable one at that.

Today we explore:

• What it's been like actually getting the podcast off the ground 🏗️
• Started from the bottom now we here…😏 (according to the stats anyway 📈)
• The good and bad, our favourite moments, and how far it's come… 🎢
• Our listenership round the world (thank you / merci / gracias / danke / grazie / شكرا ) 🌍
• Your fortnightly dose of needless, tangential pop culture; from Alan Partridge, to Johnny Depp and the Fast Show and Krusty the Clown
• The road ahead…🛣️
• The holidays! 🎄
• And of course, ARCP season….🫠

Thank you all to all of you who listen, who’ve participated and who’ve helped make Its Always Sunny in Surgery what it is. We hope you’ve enjoyed listening as much as we’ve enjoyed creating.

We love to hear from you, more than reviews, likes and subscribing (but you can do those things if you fancy…)

So please drop us a line on:

Email us: surgicalcareersnw@gmail.com

Twitter: @NW_surgical (www.twitter.com/NW_surgical)

Reddit: u/surgicalcareersNW (www.reddit.com/u/surgicalcareersNW)

Happy holidays, and see you in 2024!

Jamie & Assad

--------------------------------------------------------------------------------------------------------

Johnny Depp on Paul Whitehouse, and The Fast Show: https://metro.co.uk/2020/06/10/johnny-depp-paul-whitehouse-greatest-actor-12834920/

Alan Partridge being Alan Partridge: https://partridge.cloud/scene/?id=EXxDbCibsfpJ

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🎵…Stitch don’t kill my vibe, stitch don’t kill my vibe…I'm trying to keep it alive and not compromise the feeling we love…🎵

Slightly later than normal due to a rough on-call patch, which incidentally was the reason we did this episode. If:

• the hours are so brutal…⏳
• the training so long…😪
• the abuse so rife…😖

Why are we still here? This season has taken the scenic route through some of the worst parts of training so today we are trying to claw it back. There’s gotta be summat good right?

We talk about:

• Surprising yourself with the progress you’ve made 😏
• Good times with colleagues 👯‍♂️
• Faking it till you make it 😅
• Making it, and pulling off something mega 🧐

Maybe the real training is the friends we made along the way…?

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We veer WILDLY off topic, but have decided to reformat it for your listening pleasure. Everyone likes a freebie right?

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Just like any major cable television event, here comes another break in the action…

This season has been pretty challenging to get trainees from every specialty together. We received some messages from concerned listeners doing a welfare check when the last episode should have been released.

Fear not! We’ve not gone anywhere. We just didn’t want to release additional filler episodes whilst we are scheduling and recording the last couple. These neurosurgeons and cardiac surgeons are an elusive bunch… 👀.

Anyways, because we have no other way to communicate with everyone, here we are, another filler episode just to let you know we’re alive and well, and working on original content.

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Following on from last week's episode about the good old days of training, it sounds like we have lost our way... So how do we find it again?

We posed the question to Reddit and asked how can we drain the proverbial swamp, channel our inner MAGA and actually Make Surgery Great Again...?

We took those responses, and chat about;

• Gameshow etiquette and meta-referencing ❌
• Re-establishing the hierarchy and the firm 👨‍👦‍👦
• Segueing from Segways to safari-esque ward rounds 🦁🐘🦓🦛
• The ideal ward round 🪑👀
• Very Victorian Vocational Training 🍺🏠📏
• Restricting surgery to surgeons ⛔️
• Rotational training 🎠

Our Reddit poll providing the basis for this episode: https://www.reddit.com/r/doctorsUK/s/Dx7WFKQARj

It’s Always Sunny in Philadelphia - The Gang Goes on Family Fight (Season 10 Episode 8): https://youtu.be/MJT_aQ5XzKg?si=wZo4EN5w9C_Gakje

Scrubs - Turk’s peak ward round efficiency: https://youtu.be/JOZK1qD9usU?si=yfDbvrRqHH2LTbRA

The Cider House Rules trailer: https://youtu.be/xWpOP9NoaM8?si=SP9MfbtcFT6kJ9Nh

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Surgical trainees nowadays 'have never had it easier' apparently: back in the good old days our bosses worked 27 hrs a day, 8 days a week, scribing the ward rounds in English, Latin, and Ancient Greek, detecting electrolyte abnormalities by taste alone, whilst being paid in turnips and self-satisfaction for the privilege of being a surgeon...

These days...things just seem...like we missed out...though we're not exactly sure what we missed out on...?

Today, to help us fill in the blanks and tell us what it was actually like, we're joined by Mr. Mark Welch: former North West TPD for General & Vascular Surgery; the trainer who helped Assad find his mojo and all-round legend for a generation of surgeons in Manchester.

We sit back and let him spin us a few yarns 🧶 about what it was like 'back int' day', including:

• What training was like and the portfolio-free life... 🥼
• Having your own lists and being happy-go-choppy 🔪
• The firm structure and the sense of belonging 👨‍👧‍👦
• The mess life, fun and mischief 😏🍻
• The changes, both good and bad 🎭
• Is it better now, or have we missed out? 🙃

We loved being regaled by tales from his heyday, but equally it was sobering to hear how far things have changed....and not necessarily in a good way.

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Pronunciation: /ɑː.kɪd/

Noun: One's sibling or close friend

(Northern England, especially Manchester)

’You alright our kid? You sure? You look dead miserable; is there summat on your mind?’

This episode we’re just going for it. We’re gonna talk about burnout 🔥🔥🔥

Surgeons have the unique honour of being amongst the most burnt out specialities in medicine. We’re joined by Dr. Sobia Khan (Research Psychologist and Clinical Psychotherapist at the University of Manchester) as we get into it and talk about our own experiences of it. What is burnout? What does it look and feel like? Does it spread like an inferno or could be it be smouldering away in the background for some time?

What are the symptoms? How does it show itself and what is the relationship with depression? Is it dangerous for us and for our patients? And how can you tackle it?

Can we safely open up about it?

Taking charge of it ourselves seems like a really daunting first step, but you can’t always rely on others to protect your welfare.

We’ll give it a go though. Y’alright our kid? But seriously… are you?

————————————————

If this strikes a chord with you, you might be burnt out: https://imgur.com/a/YR1EdrT

How it can feel being training: https://imgur.com/a/IRsFsgy

Kendrick Lamar - Count Me Out: https://youtu.be/5GhhVHpPR_M?si=0333YOqYQGxkpv--

(a powerful track and music video which contains many of the aspects we touch on in the episode)

RCS England Confidential Advice and Support Service: 0800 028 0199 (24hr line)

BMA Confidential Counselling Line: 0330 123 1245 (24hr line)

Burnout in trauma and orthopaedics: a cross-sectional study of surgeons from across the United Kingdom | The Annals of The Royal College of Surgeons of England (rcseng.ac.uk)

Burnout Within UK Surgical Specialties: a systematic review https://publishing.rcseng.ac.uk/doi/full/10.1308/rcsann.2020.7058

Supporting the wellbeing of surgeons and surgical teams during COVID-19 and beyond — Royal College of Surgeons (rcseng.ac.uk)

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In the final part of our work-life trilogy, we ramp it up a notch. Today, we're joined by series veteran and Deputy Postgraduate Dean Nadeem Khwaja (Consultant Plastic Surgeon), and our overseer, boss and matriarch, and the reason this podcast exists Sadie Khwaja (Consultant ENT Surgeon) as Greater Manchester's premier surgical dynasty. We all know that surgery can be an all-consuming job and our chosen career frequently gets in the way of our lives.... but what if you're married to another surgeon? How does that even work?!

We talk about that and:

• Meeting on the job 👩‍❤️‍👨 and snatching surgeries away from your future spouse 👀🔪
• Jointly juggling theatre cases, clinics, and careers 🤹‍♀️
• Inter-deanery matrimony and the effect on fledgling marriages 👰‍♀️🤵
• How it takes an MDT to raise a child
• Do surgeon-surgeon couples understand each other better?
• What happens when the job interferes with parenting?
• Does it ever get easier?! 😅

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Twitter: @NW_surgical (www.twitter.com/NW_surgical)

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Time flies when you're having fun. And in the company of friends, we rattled through the episode pretty quickly, leaving us with an opportunity to chat shit; there's always time for that! We natter about

• Stepping up to registrar level 📈
• Some of the differences between DGHs and MTCs 🏥
• Fried chicken spots 🍗
• What its really like being a TV doctor 📺
• The reality of life in front of the camera 🎥

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If the previous episode wasn't impetus enough for you to go out and start living your life, today will be different! We are joined by two legends right here in the North West - Mobeen Qureshi and Tom Naylor: both committed higher surgical trainees 🪚🛠️🔪; both orthopods who love dem bones 🦴🦴🦴; but both have parked their training to one side to take their passions and hobbies to the next level and ended up on the small screen for it.

Mobeen took time Out Of Programme (alongside his wife Zainib, also a psychiatry trainee) to participate in season 3 of BBC's Race Across the World and spent 2 months legging it around Canada 🇨🇦 , soaking up the unparalleled natural beauty 🏕️ and receiving the warmth and kindness of strangers.

Tom is a professional ice-skater ⛸️ and has been featured on ITV's Dancing on Ice 📺 . He delayed applying for ST3 to perform as a professional on the show for a season, and is married to his wife Yebin, a word-class figure skater.

Both of these guys talk to us about their exploits, seeing the world through a very different lens and getting some much needed perspective. They talk about how time away from training has helped them develop as people and also as more rounded surgeons. They talk about their trepidation in asking for time away, but the reality that they have been encouraged, well-supported, and welcomed back with open arms by their supervisors and TPD. Crucially, its helped them rekindle their love of surgery again.

Y'know what they say? Absence makes the heart grow fonder…

So maybe it's time to pump the brakes on training, get your out of office notifications on, and have yourselves an adventure! Go on, off you trot!

Zainab & Mobeen hitchhiking, relying on the kindness of strangers and making the most of Canada - https://www.youtube.com/watch?v=ExkaOH96n-Q&t=9s

BBC's Race Across the World: https://www.bbc.co.uk/iplayer/episodes/m0002tvs/race-across-the-world?seriesId=p0f5x536

Tom setting impossible standards for regular trainees - https://www.youtube.com/watch?v=nlWj-1gjrFs&t=76s

Tom again showing he's hench enough for orthopaedics - https://www.youtube.com/watch?v=JaWzbowbvwU&t=153s

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This is probably the biggest dilemma facing surgeons of all grades, stages and demographics; how do we juggle the knife and our life? Let's call it what it is...we need to have a life-work balance. The job is all-consuming and will devour your very essence if you let it, so how do we straddle both domains successfully? In the first of this three-parter (because, let's be honest, this is a huge topic worthy of time), we discuss:

• Good habits that can set you up to maximise your day and stop admin encroaching on your free time.
• Balancing the different roles we occupy.
• Making time for your hobbies and pursuits, whether those are smashing out ultra-triathlons, going outside to touch some grass or even just binging Netflix.
• Pearls of wisdom given to us by the wise old trainers of yore, warning us to capitalise on youth and freedom so that we're left with more than regret when we finally put the scalpel down.

Remember....get busy living or you'll be too busy shivving!

Walking Britain - finding walks close to you: https://www.walkingbritain.co.uk/

Ramblers - even more meandering: https://www.ramblers.org.uk/

D.A. Parry, R.S. Oeppen, M.S.A. Amin, P.A. Brennan (2018). Could exercise improve mental health and cognitive skills for surgeons and other healthcare professionals? BJOMS 56(5)367-370. https://doi.org/10.1016/j.bjoms.2018.03.005.

Balancing a personal life with a surgical career | The Bulletin of the Royal College of Surgeons of England (rcseng.ac.uk)

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As we discussed in the previous episode, sometimes life and the job sticks the boot in, and kicks you when you’re already down. Picking ourselves up is easier said than done.

Psychology is a vital aspect of any high-performance industry because we need to believe we can do it; not just for us, but also for the people who rely on us. Sometimes we need extra help to find the right headspace.

Today we’re joined by Nicola Forshaw, counsellor, therapist and professional coach and we talk about how coaching and/or mentoring can get you back in the zone.

What’s the difference between the two? How does a good mentor mentor? What benefits does it bring? How do we combat performance anxiety? How much time do we really need in the stretch zone? Is it bad if we like wallowing in the comfort zone? Are we on the highway to the danger zone?!

Look, stop asking questions and just listen; all will be revealed. Now drop and gimme 20!

You can't say 'danger zone' without listening to Kenny Loggins: https://www.youtube.com/watch?v=siwpn14IE7E

Nicola's endeavours - Nine Coaching, Teaching and Wellbeing: https://www.nineteaching.com/

Gagnon, L & Abbasi, N. (2018). Systematic review of randomized controlled trials on the role of coaching in surgery to improve learner outcomes. The American Journal of Surgery, 216(1), 140–146. https://do.org/10.1016/j.amjsurg.2017.05.003

Lin, J & Reddy, R (2019). Teaching, mentorship, and coaching in surgical education. Thoracic surgery clinics, 29(3), 311-320. https://doi.org/10.1016/j.thorsurg.2019.03.008

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So you’ve got into specialty training? Made it to the promised land? You can turn it on to autopilot and cruise your way to the end right…?

Wrong.

Buckle up and strap yourself in! This is where shit gets real.

Many trainees will be absolutely fine, but what if you’re one of the ones who aren’t? Complaints? SUI? Complications? Failing FRCS? All these things knock your confidence which is essential for both survival and progression in surgery? So what do you do? How do you go on?

As eminent Gotham city physician Dr. Thomas Wayne once rhetorically asked his son: “Why do we fall Bruce? So we can learn to pick ourselves up again…”

Granted, even though we’re a) surgeons not physicians, b) not billionaires and c) not Batman…the sentiment still holds true.

Today we’re joined by local lad, orthopod extraordinaire and all-round top bloke Rich Unsworth (Health Education North West) as we talk about the journey from the highest highs to the lowest lows, and how you pick yourself up, dust yourself off and find the will to carry on.

It's a long slog to the end, you might end up broken, and like the name of the episode suggests, 6 weeks in a plaster cast sometimes just isn't enough....

Pinto, A & Faiz, O & Bicknell, C & Vincent, C. (2014). Acute traumatic stress among surgeons after major surgical complications. The American Journal of Surgery. 208 (4). dot: 10.1016/j.amjsurg.2014.06.018. 

Dean, E. Surgeons and mental health support. (2020). The Bulletin of the Royal College of Surgeons of England 102 (6). dot: https://doi.org/10.1308/rcsbull.2020.169

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As the unstoppable bullying endemic wreaks havoc, bringing surgical trainees to their knees with widespread anarchy and chaos, one man must face his greatest challenge to battle injustice. However, is the @orthopodreg prepared to walk the fine line between defender and avenger, hero and vigilante?

Whilst that is just the synopsis of The Dark Knight (with a few names/details changed), it rings true for detailing the mammoth scale of the problem. In Part 2 of our look at bullying, we're privileged to be joined by the shining beacon of justice that is Simon Fleming.

The self-described misfit who has long been the target of bullies, starting as a fat kid, and then joining a speciality with the worst reputation for bullying. He made it his British Orthopaedic Trainees Association (BOTA) campaign pledge to tackle bullying at its root, and then dedicated the last decade of his life to doing so, being met with scorn, criticism and vitriol. He’s been the proverbial lightning rod for the wrath of the establishment, and the metaphorical shield for trainees to hide behind, despite constant threats to his training, career, and even his life.

We talk about his life’s work, his personal experiences of bullying, how far the movement has come, where we are as a profession now, and how he will continue in his crusade as a consultant.

He is the hero that we as trainees deserve, but not the one we need right now. So he will be hunted. Because he can take it. A watchful protector. A not-so-silent guardian. Wait… is he actually Batman?

Simon's Twitter account: www.twitter.com/orthopodreg

One of Simon's most visible TED talks: https://www.youtube.com/watch?v=aVkGiziPY1o

Simon Fleming: I launched an anti-bullying campaign to change culture in healthcare (2019). BMJ: 365:l2325 doi: https://doi.org/10.1136/bmj.l2325 

Fleming, S. and Fisher, R.A., Sexual assault in surgery: a painful truth (2021). The Bulletin of the Royal College of Surgeons of England, 103(6), pp.282-285.

https://doi.org/10.1308/rcsbull.2021.106

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Well, we didn’t expect them to make an appearance during this Royal Rumble of sorts, but they were called out early on and are here to lay the smacketh down!

Today we’re joined by Alison Thompson and Sherif Shawer (Health Education North West) as we grapple with O&G. We talk about the highest highs and the lowest lows, and everything in between. Seen by some as an easy target, they’ve definitely got the respect of all us parents this season!

And it’s clear that years on the labour ward knocking out Category 1 C-sections means they have the endurance, stamina and speed with a knife to bring the pain!

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Time for some real talk! Bullying and surgery go together like drink-driving; historically seen as no big deal, not uncommon and frequently resulting in disaster. That is of course until some brave souls step in to permanently alter the landscape. Surgery is typically dominated by strong personalities and we as trainees have to learn directly from, and form close relationships with these individuals. It’s also a tough career fraught with challenge and adversity, so resilience is necessary.

However, when does it become too much? Where is the line between 'having a laugh' and 'bullying'? How much 'character building' do you need? Is bullying detrimental in surgery or is it turning you into a capable independent operator who can stand the heat in the kitchen? Do trainees just need to take a joke and get thicker skin?

No surgical trainee will have Patrick Swayze standing up for them like he does for Jennifer Grey in Dirty Dancing, but we’ve got the next best thing; (former) trainees advocating for trainees ✊.

In the first episode of this two-parter, we're joined by Dave Riding (Consultant Vascular Surgeon, previously Health Education North West) who spearheaded the Royal College of Surgeons of Edinburgh anti-bullying campaign.

We talk about the subtle beasts that are bullying, undermining behaviour and harassment. Does bullying actually result in patient harm? Have we been bullied? Who do we report this to? Should we report this? Wait, so have we bullied someone???! Are we the baddies?!

Lots to unpick…

RCSEd Anti-Bullying Campaign: https://www.rcsed.ac.uk/professional-support-development-resources/anti-bullying-and-undermining-campaign

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'Build Me Up Buttercup' is the seminal song from The Foundations and is a tale as old as time. It portrays the story of unrequited love, lovesick fools pining after the object of their desires, constantly being let down and messed around. And just like The Foundations, foundation doctors across the land endure a similar experience trying to claw their way into Core Surgical Training. And worst of all, HEE never call when they say they will!

Today we're joined by Helen Cashman (Health Education Yorks & the Humber) and Kaso Ari (Health Education East of England) and we talk about how they cobbled together an application, the abusive relationship you strike up with Oriel, practicing presentations to the point of police intervention, and their tips and tricks for avoiding the heartbreak getting in. We had a great time doing this episode talking about CST applications, because to be honest, if you don't laugh, you'll cry...

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Once we started ranting; we couldn't stop! The frustration, emotions and pop-culture references came pouring out. We had a lot to talk about and plenty of leftover audio after we actually finished recording. So we've got some bonus audio for your listening pleasure. Or not. Whatever you like!

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To err is human; to remediate divine. No that's not an actual aphorism; we just conceived that now to sound smart. Surgical training is HARD. Whilst there are those who excel, there are also many amongst us who find it a struggle. Today we're rejoined by Nadeem Khwaja (Deputy Postgraduate Dean for Health Education North West, and Consultant Plastic Surgeon) and he's brought along Jon Ghosh (Associate Head of School for Health Education North West and Consultant Vascular Surgeon). We talk about the grind, the telltale signs it's wearing you down, the support that can be provided to you and that there's no shame in saying you need help. Even the people we'd least expect have...

JG's mad skills at work: https://www.dailymail.co.uk/news/article-2604367/Heavily-pregnant-woman-forced-birth-coma-21-year-old-speeding-driver-smashed-taxi-undertaking.html

Melton, W; Benjamin Jackson III, J; Koon, D et al. Orthopaedic Resident Remediation: Frequency, Intervention, Outcomes. JBJS Open Access. (2018) 3(4). doi: 10.2106/JBJS.OA.18.00011

To, H; Cargill, A; Tobin, S et al. Remediation of Underperformance in Surgical Trainees - A Scoping Review. Journal of Surgical Education (2020) 78 (4). https://doi.org/10.1016/j.jsurg.2020.10.010

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Do you remember your first time? The first time you thought 'I fancy a bit of this'? Well today we have a natter with the future of surgery! We have Jacqueline Howard from Surgical Scousers (University of Liverpool undergraduate surgical society), joined by Orlane Foucault and Jacob Tan from Scalpel (University of Manchester undergraduate surgical society) where we talk about the first time they 'caught the surgical bug', and the experiences they've had that have fired up their interest. In return (powered by their enthusiasm), we lift the lid on what they can expect from surgical training, swap our undergraduate horror stories and do our level-best to not....talk them out of the profession and exacerbate the workforce crisis....

Surgical Scousers (https://surgicalscousers.weebly.com/)

Scalpel (https://www.scalpelmanchester.com/new/)

Surgery School (https://www.youtube.com/watch?v=md2k5BD4qfs)

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It's exam season! So today we are dedicating a bit of time to biggest challenge to overcome in your early surgical career; the MRCS. How do you squeeze studying in and around your life? Cramming or planning? What resources do we rate? How do you take it on the chin if you don’t pass?

We also get a bit philosophical; when can you call yourself a surgeon? Why do we drop the Doctor title…?

Get Through MRCS: Anatomy 2nd Edition. Simon Overstall & Amit Zaveri (ISBN: 9781444170191)

https://www.taylorfrancis.com/books/mono/10.1201/b13525/get-mrcs-anatomy-2e-simon-overstall-amit-zaveri

RCS England website - qualifications of a surgeon: https://www.rcseng.ac.uk/patient-care/surgical-staff-and-regulation/qualifications-of-a-surgeon/#:~:text=In%20London%2C%20after%201745%2C%20this,with%20the%20title%20%27Mr%27.

Loudon, I. Why are (male) surgeons still addressed as Mr? BMJ. 2000 Dec 23; 321(7276): 1589–1591. 

doi: https://doi.org/10.1136/bmj.321.7276.1589 

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"You gotta roll with it, you gotta take your time, you gotta say what you say, don't let anybody get in your way, 'cause it's all too much for me to take."

Yet another Oasis line that accurately captures the sentiment of the episode, which comes with a trigger warning as we talk about the entry into surgical training and how its changed over the years. In this episode, we're joined by Steve Tang (Health Education Yorks & the Humber) after his FIFTH(!!) crack at CST / ST3 National Selection. As frustrating as it can be to get your foot in the door, formal training programmes aren't the only way to forge a career in surgery; summat we touch on here. Thankfully, it's not all bad news as Steve's perseverance has paid off as he's finally been awarded an NTN! Well done lad! Also, RIP Jerry Springer; we definitely didn't see that coming.

Rohrer, Kennedy, and Knight. Myths of MTAS and MMC; Journal of the Royal Society of Medicine (2007); 100(6): 252-254. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1885385/

MTAS Wikipedia Article: https://en.wikipedia.org/wiki/Medical_Training_Application_Service

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It was only a matter of time before we snuck in an Oasis reference... In this episode, we get a bit existential as we discuss difficult placements, service provision, and tricky trainers. Not every placement will be plain sailing and we talk about survival tips to stop you capsizing, and help you come out smiling on the other side.

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Today we talk about how to capitalise on surgical training, maximise your learning opportunities and how you can even flip service provision into education! Don't worry Daniel-san, we will Mr. Miyagi you....

(NB All the advice provided was checked with Assad's own personal Miyagi, a two-time former TPD for both core and specialty trainees. Thanks JG!)

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Well that escalated quickly; a few weeks ago we had some specialties trash talking eyes and this week, out of nowhere, a specialty whose name we're not sure how to spell dive into the ring to rise to the challenge. Not strictly a pure surgical specialty, but they have knives 🔪 and they cut eyes 👁️. Some might say they're the envy of us all; they knock out ten times as many cases on a list as the rest of us, and all they're still home in time for tea! So today we focus the lens 🔬on Hugo Whyte and James Richardson-May (Health Education Wessex) and lift the lid on the good bits, the bad bits and the stuff they wish they'd known before starting training. Who are they enlisting for desert island survival 🏝️ and who are they taking on in a fight? 🥊 They might not be known for their physical prowess, but that doesn't matter; you wouldn't hit a guy with glasses right?! 🤓

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"I walk a lonely road, the only one that I've ever known, but its home to me and I walk alone"

We've gone national! In this episode, we're joined by Anuradha Venugopal (StR Vascular Surgery Health Education West Midlands) and James Forsyth (formerly StR Health Education Yorks & Humber, now Consultant Vascular Surgeon at the Leeds General Infirmary) to sit down and discuss the hurdles we vault in training, and the most pressing question of all.... Is surgical training worth it??

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"The TPD won’t let me be, nor the SAC so let me see. They try to shut me down on ISCP but it feels so empty without me"

In this episode we're on our best behaviour as we talk to Mr. Nadeem Khwaja, the Head of the NW School of Surgery (recently promoted to Associate Dean) about who the deanery are, how they oversee surgical training, what they do for us and finally what those bloody acronyms actually mean!

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In this introduction, we talk about: the origins of the series; our motivation (or initial lack thereof); our goals; our hopes/wants/dreams; our inspiration, the creative process and the 'love letter' to Assad's favourite show. It's definitely just a tribute. Please don't tell on us.

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This episode is all about the kids; Jamie’s got his hands full with his, leaving Assad with André Cardoso Almeida (Health Education West Midlands) marking the entrance of paediatric surgery into the ring. The circle is complete; the apprentice has become the master! First crossing paths in general surgery during CST when Assad was a junior reg, André has motored through training and recently CCT’d.

We chat about:

• Surgery on teeny tiny people with teeny tiny organs where losing a few drops of blood 🩸 has an impact on the circulating volume 🫀.
• Pulling on emotional heart strings 🎻 as a fringe benefit 😏
• The nerves of steel 😶 lying beneath a cheery exterior 🙂
• Operating on patients anywhere from a few days 👶 to a few years old 🧒, in different cavities 🫁 and systems.
• Desert island survival 🏝️
• Who could they lay the smack down on? 🤼‍♀️ Surely they wouldn’t? Not in front of the kids!

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It's tough fitting a podcast around life, training, families, kids and crucially for trainees....ARCP season! As Jeff Goldblum in Jurassic Park so succinctly says "Life...uh...finds a way". And life has very much found a way to intrude in our recording schedule. So whilst we get around to bringing in more specialties into the ring, here's a bit of a catch up amongst old friends. We talk about:

• Realising you're past it 👴
• The scientific methodology in reality TV 🔬
• Veterinary surgical subspecialties 🔪
• Surgical souvenirs 🪨🦵
• Cannibalism (as you do) 🍽️😋👀

Feline aortic surgery:

Vezzosi T, Buralli C, Briganti A, Vannozzi I, Giacomelli E, Talamanca GF, Sansoni A, Domenech O, Tognetti R, Surgical embolectomy in a cat with cardiogenic aortic thromboembolism, Journal of Veterinary Cardiology, https://doi.org/10.1016/j.jvc.2020.03.002.

Self-cannibalism following traumatic amputation:

https://www.reddit.com/r/IAmA/comments/8p5xlj/hi_all_i_am_a_man_who_ate_a_portion_of_his_own/

Radiohead being their cheery selves:

https://www.youtube.com/watch?v=2Lpw3yMCWro

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This week is the turn of ENT 👂👃🗣️and Assad has roped some old friends into the fray. We’re joined by Kate Hamnett and Joe Stansfield (Health Education North West) as we have at them; the good bits, the bad bits, the clinics (are they good or bad?), vertigo 🎭, bewildering anatomy mixed in with a bit of voodoo 🪄. And as you might expect from a bit of a catch up; we get a bit waylaid and off topic, but there’s plenty there for you to listen to!

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This episode brings the true heavyweights into the arena; we are joined by Zak Cole-Healey and Basim Dawoud (Health Education North West) as we get our teeth into maxfax! There's lots to unpick; what is it that compels a person to do both dentistry AND medicine?! 🎓

How do you afford it?! 💸

So do maxfax deal with teeth or not? 🦷 (tbh we're still not quite sure...) How do they pick up their skills?🧐 As for who they could take in a fight? Soft tissue, orthopaedics 🦴, vascular 🩸 and plastics 🔬 skills, plus the stamina for two degrees?! These guys are truly capable of bringing the pain, and also dealing with the aftermath!

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And now, a brief pause in our ongoing specialty series. We bring you our halftime show!

Well not really, we have some bits left over from other episodes we want to bring you. Unfortunately, life gets in the way sometimes and whilst we deal with the realities of training and living, sometimes scheduling, recording and editing has to take a backseat. This is still stuff we haven't released, and we will be back to bring the smacketh down in the coming weeks...

Edit: To those that brought this to our attention, thank you and sorry ... Some things are better left unsaid.

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And so, we are closing up again. We discuss some of the other finer points of this specialty series:

• The ability to amuse oneself is one of the purest joys
• Audiences in new places
• Nearly a full house of specialties...
• ....However, it's harder to remain anonymous in smaller circles
• We re-affirm our commitment to bringing you solid content...
• ...But our lives and our jobs are getting more serious now..
• Our plans for next season

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Brought to you in the middle of ARCP season and family holidays, we get introspective and put ourselves under the microscope, to explore why we ended up down the the route we did 🔬

• Why do so many brown people end up in medicine?👳🏾‍♂️ 🩺
• Is it hardwired into ethnic DNA?🧬
• Cultural and racial differences we can only discuss as friends…😬
• Private vs. state education and the relative merits of each 🎩 🍾
• How is the transition into the surgical persona beneficial for life? 🧑‍🧑‍🧒‍🧒

=============================

John Cusack in ‘Say Anything’: https://youtu.be/VEgu7jdc_fs

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Don't worry don't worry! Thank you for your concerns for welfare, we've not had a bust-up or lost interest; it's just that life/work/training/families get in our way and are making it increasingly difficult to find time to record. And with it having been ARCP season recently, we set our portfolios to overdrive at the expense of everything else.

What starts out as a catch-up devolves into a lengthy chat/rant about:

• Prophylactic tie-wearing to assert dominance
• Training and the conflicting directives therein
• Selling out to corporate sponsorship
• Peppa Pig
• Medical superstition

And more... Anyways aside from chronicling our trials and tribulations, we strategise on ways we plan to deliver what we set out to deliver in this season. More episodes to follow!

================================================================

The clip from Wayne's World https://www.youtube.com/watch?v=8lgLYGBbDNs

Orthopaedics vs. anaesthetics BMJ Xmas study https://www.bmj.com/content/343/bmj.d7506

Just like Stevie Wonder says, superstition ain't the way: https://www.sciencedirect.com/science/article/abs/pii/S0883944118303770#

The Peppa Pig effect https://www.theguardian.com/tv-and-radio/2021/jul/19/peppa-pig-american-kids-british-accents

This episode was actually recored on the day the man, the legend Brian Wilson died, inspiring the title of this episode https://www.youtube.com/watch?v=5lP8BZcyoEQ

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This week has us scoping out surgeons in the media and our favourite examples. Are these portrayals accurate? Where exactly do they come from? Which ones are based on just pure stereotypes and which ones must be getting that insider information?

We discuss:

• The historical hassle of having to arrange out of hours imaging 🩻
• Every surgeon’s dream ward round 🏃🏽‍♂️💨
• Art imitating life 🎨
• The little details that make these programmes particularly poignant 🚰
• The worst examples never show the admin we do! 📑
• No matter how over the top, there’s no smoke without fire 🔥
• And, as a little extra (keep tuned to the end!) some people getting it all mixed up 🙃
• Also, some of the joys of a decent hairdresser 💇‍♂️, a proper brew ☕️, and a chance to offload 🗣️

There are SO many examples that we didn’t get to cover, so we will probably come back to this topic again.

Here’s some of the source material we discussed in the episode:

• Simon Bramhall liver guy with the initials in the liver https://www.bbc.com/news/uk-england-birmingham-59954321
• Psycho plastics guy Nottingham stabbing his colleague https://www.bbc.com/news/articles/c3d8nymg12zo
• Scrubs - Turk doing rounds https://youtu.be/JOZK1qD9usU?si=vrn-6SZXCPs1lRVs

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It has oft been said that “The heart of a lion, the eyes of an eagle, and the hands of a lady maketh the surgeon.” Well then, time to get into it! Who or what are surgeons? What makes us tick? Do we really need the ❤️ of a 🦁, the 👀 of an 🦅 or the 💅of a👩‍💼 to do the job well?

• Are the characteristics needed to be a surgeon hardwired into us? 🧬
• If surgeons were made to wear the Harry Potter sorting hat, what house would we be, and what does that say about us…?🐍
• We get introspective about our own personalities and how we fit into this work persona 🔬 🤓
• How much crossover is there between us and psychopaths? 🫣
• Are we really more attractive than other types of doctors? 💁‍♀️
• What does it all really boil down to…? 🔪🙏

———————————————————-

Additional sources discussed in this episode:

Well, we're not gonna argue! 😏 https://newsfeed.time.com/2013/08/30/survey-surgeons-are-the-most-attractive-doctors/

Yikes 😬 https://publishing.rcseng.ac.uk/doi/pdf/10.1308/rcsbull.2015.331

If you say so...https://www.prospectmagazine.co.uk/culture/44562/some-surgeons-may-be-psychopathsbut-thats-no-bad-thing

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We're back after a very lengthy break! In that time we talk about:

• Snow days and the joys therein ☃️
• Moonlighting when you're off the clock / back-street quackery 🦆
• Pumping those logbook numbers up! ⬆️
• Flirting with disaster...😅

But essentially, we're using this episode to mark our transition into what we have planned for this season, and that is to get all existential and explore who or what are surgeons? What makes us tick? What makes us cut? Is there an archetypal surgeon? How relevant is that in today's workplace? 🤔

All / probably some of these things will be explored in the forthcoming season.....ARCP pending. Ha.

(As mentioned previously, we have to reduce the frequency of episodes to monthly for our own sanity, well-being and to ensure we still have our training numbers 🤞)

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