It's Always Sunny in Surgery

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

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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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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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