https://orcid.org/0000-0002-7224-1642
Dear guests, members, friends, and my family,
Now that you have been introduced to, the formal aspects of my life allow me to share the feelings I have gathered over the past year.
Nonetheless, 1st, let us go back a few years to a tradition in our city—a serenade. After the final semester, students serenade their teachers. Just as we did in my time.
When the anatomy professor realized that only a few words could truly stay with us in that special light-hearted moment, he left us with a life quote:
Assess yourself on a global scale.
Years later, when I fully grasped the meaning of that sentence, I realized that ESTS was my gateway to the world. It was an easy recognition, as I had no other options because my boss (Imre Troján) and one of my colleagues (László Kecskés) were the founders of the ESTS. I began working with ESTS and, finally, in the last year, with your trust and confidence, I was privileged to represent the Society on the global stage. Words cannot express how honoured and grateful I am for this prestigious role.
During my presidency, I attended many meetings and met many trainees and experts. I engaged in countless discussions about our speciality, science, surgical techniques, theoretical background and colleague relationships.
The vital topics of these conversations included: (i) the new robotic techniques in thoracic surgery, (ii) new surgical procedures for sublobar resections, (iii) new oncological drugs that changed our previous protocols in lung cancer treatment, (iv) new concepts in transplantation, (v) sustainability, (vi) presence of artificial intelligence in our work, (vii) training of residents and (viii) position of women in thoracic surgery.
These topics reflect that we live in a revolutionary period and are tasked with using these new methods to offer better patient services.
ESTS MISSION
Our mission is to improve quality in all aspects of our speciality: from clinical and surgical management of patients to education, training, and credentialing of thoracic surgeons in Europe and worldwide. (ests.org)
To complete the ESTS mission, we must follow the words of the time and adapt our activities to these changes. I am proud that the ESTS is at the forefront of these changes. All the newest scientific topics are presented and widely discussed in our conferences.
During my presidential year, I realized that one of the most frequently discussed topics is training, which sometimes can be challenging. Achieving successful results requires 2 different generations to work together.
In the ESTS, 10.8% of the trainees and 89.2% of the specialists are members, and these 2 groups belong to different generations with different characters.
Our trainees belong to generations Y and Z, whereas the seniors are boomers and gen-Xers.
According to generation experts, the youth raised in the digital era are self-centred individuals with a different vision of work than boomers and gen-Xers. Generations Y and Z prioritize their personal life and family before work. I know that these are general characteristics and may not apply to everybody. However, it is interesting to see the opinions of our young colleagues about their work and life.
FROM TRADITION TO TRANSITION
(Navigating through the healthcare workforce crisis. Junior doctors’ experiences and proposals for the future; https://www.juniordoctors.eu/tradition-transition-navigating-through-healthcare-workforce-crisis).
In this publication, junior doctors from 24 national medical associations in Europe presented their experiences and proposals for the future regarding healthcare.
The keywords of their feeling are the following:
‘DISAPPOINTMENT AND JOB DISSATISFACTION
WORKLOAD STRAIN OWING TO HEIGHTENED HEALTHCARE DEMAND
GENERATIONAL SHIFT
REDEFINING PROFESSIONAL CALLING
RESIGNATIONS FROM CLINICAL ROLES
SHIFT IN SPECIALTY AND CAREER CHOICES
GENDER INEQUALITIES
CROSS-BORDER MOBILITY’
They stated that ‘they are increasingly seeking opportunities outside direct patient care and the medical profession’. They face restricted professional growth and limited training. Women junior doctors often face career interruptions, part-time work biases, speciality segregation, pay gaps and workplace violence. Junior doctors prioritize their families, personal time and personal and professional development.
They stated that ‘the dominant concern for them is work overload: accommodating many patients compared with the available time, increased bureaucracy, and the permanent need to “put out fires.” These factors cause physical and mental exhaustion’.
Here, we are dear colleagues. The world is changing; everybody must adapt to the changes. As I travelled around last year, I realized that everybody faces these issues.
GLOBAL CHALLENGES REQUIRE GLOBAL CHANGES
Although this declaration came from the junior doctors, most of us agree with some of these statements. We know that, historically, almost every change has come from the young generation. Certainly, their claims are reasonable and legitimate. Everybody wants to work in better conditions and can agree with junior doctors on some points. The junior doctors want to change the system, which is why they ‘woke’ us up. We cannot push our heads into the sand. We are responsible for our patients.
SENIOR DOCTORS CANNOT LET THE JUNIOR DOCTORS LEAVE THORACIC SURGERY
We must keep the juniors in service, but with better conditions, because otherwise, we may see a shortage of thoracic surgeons. Perhaps not in academic centres, but globally, it will.
By 2030, in the USA, the available thoracic surgeons will not be sufficient to meet their demands. Thoracic surgical cases will increase by 70%. Considering that, we have a mission, we must think ahead.
The junior doctors have recommended solutions to revitalize the healthcare sector.
‘GOVERNANCE
WORKING CONDITIONS
WORK AND WORK-LIFE BALANCE
OCCUPATIONAL WELLBEING
TRAINING
ADDRESSING INEQUALITIES’
Under the working conditions they stated, ‘increased flexibility in the workplace, …. limiting and monitoring of work hours, compliance with European working time direction (EWTD) and ensure rest periods’.
Regarding training, they propose to ‘standardise training across Europe and allocate time for professional development, …… allocate sufficient training time for both trainees and supervisors’. Fortunately, the recommendations for European training standards for thoracic surgery were published in 2018 [1].
The key point to creating a better work environment is collaboration: collaboration between the trainees and the seniors; collaboration between 2 different generations; and collaboration between the self-centred and work-centred generations. It is not impossible. We must only understand and accept the opinions of the other generation.
It seems easy, but in our job, 2 unique factors modify these clean, promising, and apparent concepts. One is the patient and the other one is the set of practical skills.
HIPPOCRATIC OATH AND PRACTICAL SKILL
We took the Hippocratic oath. We have to do our best to treat and manage our patients.
In this matter, nothing <100% skill is acceptable. We embark on a long and tiring journey to obtain the necessary skills, but the skills will define our success and personal reputation. As a Hungarian Nobel prize winner physician (Albert Szent-Györgyi) said, success depends on 10% talent and 90% hard work. At the last AATS meeting, Schwarzenegger confirmed the same message: ‘There is no magic pill that can give you skills without hard work. Forget it’.
Translate these words to the question of training. The junior doctors stated that the limitation of the working time to the European standard is part of the solution. Nonetheless, parallel with that statement, they complain about the lack of time for academic activities.
They recommend allocating sufficient quality training time for trainees and supervisors and time for professional development.
Obtaining skills in thoracic surgery takes time, and proficiency comes a little later.
The junior doctors said frustration is one of the key points among their issues: ‘Many feel they cannot deliver the best patient care, leading to pronounced frustration’. To surmount the frustration, they need adequate skills. At this point, the seniors must help the juniors overcome the frustration barrier quickly, but they must spend time doing it. Unfortunately, no magic pill exists.
TRAINING AND MENTORSHIP
An emerging question on how to get skills is, ‘How can we manage the training?’. One of the most effective methods is mentorship, which can be helpful if it is effective. However, if we look at the trainees’ opinions about mentorship, we can see that they are not fully satisfied with the outcomes (Fig. 1).
Satisfaction with clinical training and mentorship in thoracic surgery (Permission: Dr Daddi).
This reflects our training and mentoring activity, and we can conclude that many seniors must improve in the mentorship they provide. The head of the department cannot allow a useless training and mentoring program to continue.
BECOME A MAN OF VALUE
It may be that your resident is the 21st trainee in your career, but you are their first boss for them. You are forever THE FIRST BOSS—you must be the best boss. To be the best boss, you must be the best in humanity, knowledge, practical skill and moral character. Einstein similarly stated, ‘Try not to become a man of success. Rather, become a man of value’. These are crucial words.
IKIGAI
A Good Boss is also responsible for the trainees and the other seniors. The leader’s responsibility is to encourage colleagues and minimize stress in the workplace. Give them vision and motivation. ‘To remain healthy, man must have some goal, some purpose in life that he can respect and be proud to work for’ (Hans Selye). In Japan, a single word, IKIGAI, summarizes the ‘reason for being’: a reason to get up in the morning and enjoy the meaning of life-passion, purpose, something one lives for.
BURNOUT AND DISCRIMINATION
Without purpose and acceptable working conditions, the harmony of the department disappears, and conflicts and burnout arise. Among the surgeons, 38% of the residents and 50% of the senior surgeons have symptoms of burnout, and 4.5% reported some element of suicidal ideation. The prevalence of burnout was 42% among women and 36% among men trainees. Discrimination based on gender, race or pregnancy and childcare status was reported by 20% of the men and 66% of the women. Many of these abuses came from the patients and the families of the patients [2]. A leader must reduce the chance of the appearance of these extremities.
WOMEN IN THORACIC SURGERY
Do not forget that behind each of your colleagues is a family. This is exceptionally true if your colleague is a woman with children. Be understanding. The bosses and co-residents must be understanding. We must consider the role of our women colleagues and help them. Currently, the ESTS has 435 women colleagues, comprising 25% of the membership. According to a European survey, women are under-represented in leadership and research. Their average earning are 40% less than men because they are forced to work part-time or in lower-paid sectors to fulfil their family responsibilities. We must appreciate their effort, support them and keep them in the thoracic surgery community [3].
ADAPT TO NEW TRENDS
The new technical demands can cause challenges for you. Do not be satisfied with your results. You may be the best in a particular field, but assess yourself according to global standards, and you will understand there is room for improvement. We have to adapt to robot-based techniques and new ways of treatment.
Do you know this man trying the robot? (Fig. 2). He is Toni Lerut, our past president. With high probability, he will not use the robot in everyday practice, but he is interested, curious and open-minded to new things. We have to follow this attitude. Learning new procedures may be inconvenient, but we must follow and adopt new trends—robots, AI, 3D and neoadjuvant immunotherapy, among others. As children of the digital era, junior doctors may learn the latest methods more easily than senior doctors. This is not a problem. ‘Failure is success in progress’—said Einstein. Be patient and do it again. Learning curves never end. Think about the final goal: better service to the patient.
Age-less curiosity.
ON THE SHOULDER OF YOUR BOSS
Dear residents, most individuals are social by nature. Nobody can be a self-made person. We all need help. You get help and education from your leader when you are a trainee. The time will come when you have to give back this help to your boss and your future trainees.
The quote says: ‘If I have seen further than others, it is by standing upon the shoulder of giants’ (Isaac Newton). Stand on your boss’s shoulders, but not on their head. If you ever had any negative experience with your boss, do not give it back; forget it and be wiser. Stand on their shoulders, see further, be a better leader and your team will respect you for it.
SHOULDERS I HAVE STOOD ON
I have worked at the same institute for 35 years, but I was trained across many wards. From here, I thank everybody for their help.
During my time as a trainee, I worked with my boss (Imre Troján) and co-trainee (Tamás Szőke) (Fig. 3). We spent a fruitful time together. We learned a lot from each other and motivated one another.
My colleagues in my trainee time (Athen ESTS Spring Meeting).
I had the privilege of getting to know the big names and icons of thoracic surgery in Toronto (Griffith Pearson, Robert Ginsberg, Shaf Keshavjee, Gail Darling). Although I spent only half a year there, I respect the TGH as my alma mater.
While I was away from the department last year, my colleagues cared for my patients and worked instead of me (Fig. 4). I am grateful for that.
My colleagues 2024.
Without the permanent support of the ESTS Board (Fig. 5), my work would not be successful. Working with many talented, modest and brilliant experts was a great honour. I immensely enjoyed it. Thank you.
ESTS Board 2024.
I would like to express my endless gratitude to Sue for her polite help and professional knowledge (Fig. 6). I am deeply sorry that the ‘SuESTS’ period is over.
With Sue in Milan.
My family has been fantastic this year. They supported me unconditionally, and they never complained. I am grateful for that.
My year as president passed as if in a second, and based on the experiences I learnt, I must confess that the quote is valid:
Assess yourself globally and embrace change.
