 So I am going to be speaking next. And I really quibbled with Mark about where I should be, seasoned surgeon or young surgeon. And he said there was no question, which was really depressing. But I am real happy to be here with you. I'm sorry that I wasn't here yesterday. I was on my way back from a surgical congress in Greece. And so if I'm appearing to suffer from jet lag today, I'm sorry. But I'm trying very hard to avoid the presence of jet lag. So I have no disclosures. And Mark told me that in my topic today, my talk, he's told me moments ago, shorten your talk. So with that being said, I want to talk a little bit about training surgeons and ethics. And this is my outline. We don't have to spend a lot of time because you're going to be here for it. So the stages of surgical education, as I see it, are really four stages. And many people may disagree with this. And perhaps it's not an exact chronological stepwise movement through these stages. But I do think that this is a way to think a little bit about it. The first stage is identification of ethical issues. And this is what I would refer to as the sort of fire spotting. You're sort of looking around. OK, there's an ethical issue. There's another one over there. The second stage is sort of OK in an educational program. We have ethics-focused educational work. So for example, in a surgery department, we're doing surgery now. We're having a surgical conference. And now next week, we're doing ethics. We have an ethics conference next week. And so that's sort of a second stage. And then I would say that is kind of what we do with the surgical ethics case conferences, which we have a couple times a month. A third phase is this integrated ethics discussion. So we integrate ethics discussions into surgical conferences. And the paradigm of that is the surgical ethics M&M discussion. And I don't have to spend a lot of time talking about it, because Karen Devin will be spending more time. And then the fourth phase is what I call mindfulness. Now, many people say, well, mindfulness, what is this mindfulness? We've not seen this described. So let me tell you, it's not a religion. And it's not a hippie thing. And it fortunately does not involve yoga. For any of you who have ever seen me even try to sit cross-legged, this does not work. So what I would say is this mindfulness, as I think about it, is the complete integration of the ethical dimension into the care of every patient. And so I would say this is what we ultimately want ethics education to be, which is not, I'm a doctor and I'm taking care of patients. And occasionally I think about ethical issues. But rather, that the ethical considerations are completely infused in my care of every patient. And so I see that as sort of the ultimate goal. Now, in terms of these stages, this movement from the second stage to the third and fourth stages, I do believe requires surgeons to be trained in ethics who are comfortable with and able to lead integrated discussions. And so in the first two stages, it's very helpful. And it's been certainly used by many, many departments to bring in outside ethics experts. So a surgery department will have the Head of the Ethics Committee come in and give a lecture. We'll have an ethicist come in and participate in a discussion. And that's valuable, helpful, and don't get me wrong. There's no negative about that. But I would say what's even better is if you can integrate it, you need someone who has much more of a basis in surgery to be able to participate in those discussions. So what have we done then with respect to training surgeons and ethics at the University of Chicago? I mentioned the surgical ethics case conferences. We have these a couple times a month during the academic year. We have ethics discussions at our M&M conferences, sort of dedicated time once a month. We have an introduction to surgical ethics at the surgical intern orientation program. And so this is what we call the intern boot camp. So they come in, spend a couple of days, learn how to do important things like answer pages, and log into the computer. And so during that time, as part of that critical information is thinking about how to analyze an ethics case, how to analyze a surgical case from an ethics point of view. We continue to have grand round presentations on ethics. Occasionally a journal club will be focused on an ethics related article. And then a periodic ethics curriculum for surgical residents. This is what I've referred to as the basic surgical ethics curriculum. We did this through a lot of efforts by Melanie Sir who you'll be hearing from shortly. 2015-16, we had 10 sessions. It was an interactive case-based program covering the usual topics that we thought were important. I won't spend a lot of time talking on this because otherwise Mark will kick me off the stage. So we of course have had surgeons participate in the ethics fellowship. And this has really been something that it's not for every surgical resident or fellow, but for fellows residents and even faculty who have a particular interest in gaining that extra depth. The ethics fellowship has been wonderful. And over the years we've had 60 surgeons who have been McLean Center ethics fellows and you're obviously hearing from some of us this morning. This is just a graph because as a surgeon it's hard to present a talk without at least some graph. Although I don't have P values, but I got a graph for you. So if you look at the graph here, what you'll see is that the red, which maybe doesn't show up well, are the surgeons and the blue are the non-surgeons. So early on there were a surgeon here or there in 2002, 2003 the year, I think I was here, there were two surgeons, but mostly it was one surgeon most years until recently. Prior to 2007, there were 12 surgeons was 5% of the trained ethics fellows. Since 2007, 48 surgeons, 24%, almost a quarter. So why the increasing numbers? Well, I think a few things. I would suggest it's increasing realization of the importance of the topics, role modeling from faculty who have done the fellowship, surgical residents and surgical fellows who have done the ethics fellowship and really are our best recruitment strategy. Other residents see the residents who've done the fellowship and talk about how valuable it was and that's better than anything I could ever say. There's been enthusiastic support from department leadership and surgery and in fact it has now become somewhat of a point of distinction for our residency program and many of our fellowships that during the recruitment process when we either for the residents, when we have students coming in to interview the presentation about the department or for fellowships the presentation about the program is we have an interest in ethics. You have the opportunity to do an ethics fellowship. We have all of these opportunities built into the curriculum. So let me turn just for a second to expand upon some of the things that Ira mentioned with respect to the American College of Surgeons and surgical ethics. So at the American College of Surgeons Clinical Congress so the Clinical Congress is the big meeting every year in the fall. There's been a long-standing ethics colloquium with four cases, a discussion. There's often been a pro and con debate. Many of the surgeons who have been ethics fellows here have participated in those. We have the John Jay Conley Ethics and Philosophy Lecture. This is a long-standing lectureship previously given by Ira Kodner as well as Mark Siegler and increasingly surgical ethics programs elsewhere throughout the conference. We've had town hall meetings on ethics, meet the expert lunches, panel discussions that relate to ethical issues. The scientific forum session, Ira mentioned this research project and looking at the outcomes of the Camongar grants. And in fact, the scientific forum is the opportunity to present empirical research. And now there's a dedicated session on ethics and end-of-life care. We had recently the third year of this dedicated session. There's been an increasing number of abstracts every year. And if you look at the rate of increase in the numbers of abstracts year over year, it's the highest growth of any subject area. Now you could argue that we started low and we're coming on strong. And so I won't show you the actual numbers, but the rate of growth is very high. So you got to focus on the positive. Now, for those of you who are thinking about what empirical research project can I do, keep in mind that the deadline for next year's clinical Congress abstract submission deadline is approximately March 1st. It hasn't actually been announced, but it's always the beginning of March. Well, what about the fellowship? How could we expand that? Well, recently a joint program between the American College of Surgeons and the McLean Center started in 2015. We have a national selection process, partial support for surgeons to come to the McLean Center as ethics fellows from around the country. Peggy Kelly is the second fellow this year who's working with us and has great projects ongoing. And we've received a number of applications already for next year. So we really think that this is an opportunity to expand the reach. There is a surgical ethics interest group. This has now come to be known as the SEAG dinners. It's just a coincidence. So through support of Washington University and the McLean Center, it's been this informal networking dinner for surgeons who are at the clinical Congress who have an interest in these areas. We've had 30 to 50 attendees, each of the last four years. And it's been a discussion of numerous things, either challenging cases, how to do research in ethics. This past few weeks ago, we had a story slam on cases of regret that I found really to be very moving. In addition, the college has a newsletter that our newspaper that goes out monthly to the surgical members. And they've been nice enough to let me write a column a couple times, every couple months. I refer to it as the right choice. There is a question mark there because initially it was just the right choice without a question mark. And I thought that was not exactly the way we want to present this. But what I have found is that although I try to write scholarly articles, these 800 word essays are what people read more than other things. And I write them when the assumption that nobody reads them, but apparently people do because they write me often letters about them. For the 2017 Clinical Congress of the College, we've proposed a postgraduate course in surgical ethics. Gretchen Schwarzie has been nice enough to agree to co-direct it with me. It'll be four additional hours of CME credit. It'll fulfill the ethics requirement in some states. We do have an ACS Surgical Ethics textbook. It's multi-authored, edited by myself, Alberto Ferreros and Eric Singer. We anticipate completion in the fall of 2017 and hope that this will be a valuable reference and resource. What does the future hold? Well, Niels Bohr, winner of the Nobel Prize said in 1922, prediction is very difficult, especially about the future. And, but the beauty of talking, making predictions about the future in any given talk, and I found this to be very effective, nobody can complain that you're wrong when you predict the future. Because first of all, nobody remembers what you said after five minutes, let alone 10 years. And if they do think back 10 years, they won't remember what you said. So it's all my opinion. I do think that practicing surgeons and organized surgery have accepted the importance of surgical ethics. This is a big change from what it was like when I was applying for residency programs and said I was getting a PhD in philosophy, was interested in ethics, and I wanted to combine ethics and surgery, and I applied to probably 20 programs, and one person asked me how I was gonna integrate that. Nobody else even thought that it was relevant to ask. There's clearly increasing national and international interest in ethics. I'm very hardened to see our finishing fellows and residents who have done the ethics fellowship who tell me that it was in fact part of their recruitment was we want you to participate in the ethics program at our institution, and that I think is really a phenomenal thing and speaks to the value of the McLean Fellowship. I think that surgical grand rounds is something that many of us get invited to give grand rounds talks as visiting professors, and I've found that increasingly, if somebody asks me to give a talk, it's not about endocrine surgery, which is what I do clinically, but it's about ethics, and I think that that's a heartening thing, and there have been invitations for international presentations on ethics and surgery in France, Taiwan, China, Hong Kong, Korea, most recently Greece, and it's really interesting because every time if I give a talk that's on surgical ethics, the response is always we've never had a surgeon give a talk on this in a surgical congress, but we're very interested, and so I really do think that that's a valuable thing for the future. So thanks to the support of the McLean Center, I do think that the future of ethics and surgery looks bright, and thank you very much for your attention. So we're gonna move on immediately now to the younger surgeons. This is the group that you've all been waiting for. I know the first person that I'm gonna introduce is Dr. Melanie Sir. I mentioned Melanie a few minutes ago. She's currently assistant professor of surgery at Mount Sinai Health System. Melanie came here as a surgical oncology fellow, and if that wasn't enough, she also did a medical education fellowship and a fellowship in the McLean Center, and she's really done some phenomenal work, and I must say for me there's nothing better than seeing how great the people that I at least had a small part in training have done as they've left the University of Chicago. So Melanie, welcome.