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Uh at the beginning of October and that's in Southeast London. Er, so I'm going to focus on, um, a little bit about why, why I've chosen orthopedics. It's gonna be different reasons for, for, for everyone. But I wanted to just give you a bit of an overview of, of my reasons. Um, a bit of an overview about core surgical training, exactly what it's like my current experiences. Um, and then finally talk a bit about applying for core surgical training. I think that should mainly be the goals of, you know, after you graduate from medical school, the goals of F one and F two are to then start, um, preparing a portfolio and I'm gonna go through different parts of the portfolio and things that you can do early and things that you can leave till a little bit later. Um If you've got any questions, you can ask them at the end or you can pop them in the chat and we can, we can ask them as we can answer them as we go through. So as I said, why orthopedics say it diff different people are gonna have different, different reasons. These are some of, some of my reasons why I've chosen orthopedics, I chose to, to, to pursue orthopedics, but I did an f three year and II spent 12 months, um, as a, as a junior clinical fellow in, in an orthopedic department. And it was then that I really, um, sort of fell in love with the specialty. I always wanted to do surgery before then, but, um, sort of narrowed it down to orthopedic through if three. So the first reason I think is that it's very, very practical and very procedural. Um, and usually when we, when we talk about surgery, we, we like the, the practical aspects in theater. Um, but it's also very practical outside of theater. Um, so often when you go and see patients in A&E, they've got um, fractured fractures and, and, and part of that may be to put people in plaster, it may be to um, manipulate, manipulate fractures in the emergency department. So, on, on the left, I mean, this is just a, uh, uh, some X rays of, of a patient's um, wrist from, from a couple of weeks ago, she came, a lady came in with a, with a broken wrist, um, following a fall on outstretched hand, we put a hematoma block, gave her some Entonox, um, manipulated her wrist and put it, put it into a plaster and that just sums up, you know, orthopedics, you do something, you get something into a better position, you send her home and this lady didn't actually turn out needing to have an operation. The next reason is the operating I think is very fun. Ultimately, you're, we're operating with, with power tools and, and fun equipment, you know, soaring bones, drilling bones, putting screws in plates, knee replacements, hip replacements. These are all quite fun, fun operations. And as you start to see some orthopedics, um hopefully you guys will, will, will feel the same way about that too. Orthopedics is quite, quite um sort of unique in that there's, there's immediate feedback at, at, at the time of um operating, especially with trauma because we're using x-rays intraoperatively. And so you can see what you're doing, you can see what's going well, what's not going well. Um And you have an exact sort of timeline of what's happened in theater by looking through the X rays afterwards. So the point that you put a guide wire in the point that you put the nail in and you can see again, this is an X ray from, from a case a couple of weeks ago that I, that I did, the patient comes in with a hip fracture and you can see by the end of by the end of the operation now, got this nail down the femur. Um Everything's looking like it's in a good position. Um And it gives you immediate feedback of, of what you've just done. The, the operating is quite varied as well, and this is especially the case of trauma. Um, so you're operating on all, all, all sorts of people, kids, elderly people, um, anyone can fall over break bones and sort of anyone can need, need, need an orthopedic operation. It's not like you're just, um, operating on a particular age group. Um, so, so yeah, kids, kids come in with supracondylar fractures which, which need operations. Old people come in with, with neck of femur fractures and sort of anyone in between falls over and breaks bones. So it's very varied operating and also with regards to the limbs that you operate. So upper limb, lower limb, different operations, uh different fractures require different operations. So it is quite varied. I also, I always quite liked er, anatomy, even at medical school, I, it was probably one of the, my favorite parts of medical school and what I enjoyed learning the most was anatomy. Um, and you're using that anatomy on a daily basis, whether you're operating on hands, upper limbs, lower limbs, you're using your knowledge of anatomy where the, where the radial artery is, where the median nerve is going in the plane in between to, to fix someone's broken wrist and applying that anatomy is something that I like about orthopedics as well. And then finally, a couple of things, quick ward rounds. I've never really been a, been a, been a fan of long ward rounds. Uh orthopedic ward rounds tend to be the the fastest. So that drew me to the specialty. Um And then finally, we don't often talk about money and medicine and talk about private practice. But there are opportunities for, for private practice down the line when, when you, when you reach that level and that, that's, that's, that was an attractive um aspect of, of the specialty for me as well. So core surgical training, um it's a, it's a two year program, You do it after foundation training and prior to specialty training, uh still two years, I know medical training and, and some other specialties have changed to a three year program, but core surgical training is a two year program still. Uh It's either got four or six month rotations. Um My core training, I've had 46 month rotations and they are often themed so they often have a general surgical theme or an ent theme or a plastics theme or an orthopedic themed. Um And it's quite important to get a themed program um because this really helps you to um further sort of narrow things down and, and, and will help you when applying for specialty training again, different with surgery compared to medical specialties in that with surgery. A AAA lot of your application for ST three is going to require certain er, operations and you, you'd have certain numbers in those operations, but you do also need quite a lot of knowledge and the specialty for the ST three interview So it's very good to have a themed program to allow you to get those numbers, whether it's DHS numbers you need 12 or so for, for ST three and, and you don't want to be, you don't want to try and cram all of those into four months. So you want to have orthopedics, you know, at least 12 months, I would say during course surgical training if you really want to get the most out of it, um It's it is competitive. So I've got the figures for 2021 2022. It's one of the more competitive um sort of surgical, one of the more competitive compared to medical training cause surgical training. Um but it, it's, it's definitely doable and I think you just need to be slightly more prepared with it, build a portfolio towards course surgical training. Um And we're gonna go through some of that, some of that uh towards the end of the talk. Finally, the um M sra was, was introduced last year for the for this current years um applications. So previously it was just your portfolio that was used to shortlist. So you would apply, you would um upload your portfolio evidence and then based on your portfolio score, you used to get an interview. Um but they've changed that this year, just a another way that, that they change things every year and they introduce things and they take things away. So you always need to be a little bit, you know, alert to things can always change. Um, the M SRA is basically an exam that was introduced. Um, and they use your score to shortlist based based on your M SRA score. I don't know much about the M SRA exam cos I never took it myself. Um, but I believe half of it is sort of medical knowledge and the half the other half is, er, a sort of like an S JT judgment test, er, kind of exam. It's used for multiple different specialties. GP use it, radiology, use it. Uh I think anesthetics use it as well. So a lot of the different, different, er, training programs are using the M SRA now. Um again, you just have to be a bit more prepared about it. There are lots of courses you can go on for the, for the M SRA as well. Um So at the end you then get a, get a score for your, for your core of surgical training. Er, the scores broken down originally began before the M SS RA. It was just a third, a third, a third was portfolio, a third was clinical and a third was um management. Er, but then the M SRA is now taking up 10%. You will then get a score at the end, you get ranked nationally based on your score, you rank jobs, um, and, and you get a job based on, based on your overall score. So it is important to, to try and build a good portfolio cos that's gonna count to for 30%. But it's also important to uh do well in the interview cos the interview is 60%. So course surgical training, it gets a lot of bad press. I think, I think medical training in general gets a lot of bad press. Um Me personally, I've had a, I've had a really good time as a, as a surgical trainee. As I said, I've done two years, I've done 18 months of orthopedics. I spent all of my two years at DG HS. Um, and I've had really good experience at all, at all. The hospitals that I've worked at different locations suit different people. So some people want to be in London, some people want to be outside of London and it's really a personal choice. Um, and it's something that you will need to think about. Um, and really talk to other people, talk to current trainees, talk to registrars. Um, and just, and just get an idea of what's, what's, what's the difference, what the difference is. Um, and, and it's something that you, you will, you will choose yourself and then within the, within the sort of region you, there's lots of different hospitals that you can be at, you can be at major trauma centers, you can be at tertiary centers, you can be at DG HSI. Wanted to spend most of my time at AD GH in my course of surgical training. Again, it was just a more of a personal, personal choice because I did an F three, I did an, I spent an F three at a tertiary center. So I wanted to, to experience more of AD GH during my, during my CST, I thought I'd just put in my sort of average week. So I wrote this talk at the beginning of beginning of this week and I just wrote my week for the, for the week before. So you can see, you know, I think there was, I was on call on the weekend, but I still had quite a good week at work. So on the Monday, II stepped up to, to be the reg on call, there's lots of opportunities during er, surgical training to step up, especially as Act two and step up and take the registrar bleep. Um, w which is a really good experience on the Tuesday. I spent the day in the theater Wednesday. I was on annual leave because I'm trying to move house at the moment. Er, Thursday, II was, this was my zero day before the working weekend and I worked Friday, Saturday and Sunday. Um, so on my, on call weekend, I was clerking surgical patients at my current hospital. I actually cross cover. So I cleer all surgical referrals, that's general surgical urology and orthopedic referrals. Er, but in between seeing cases in A&E, I was able to go to go to the theater and in cases. Um So you, you know, you get that, that bit of mix as a, as a surgical trainee when you're not just seeing patients in A&E you, you, you, you, you need to go to the theater to assist. Um and it helps break the day up. It's also fun. Um And yeah, that's one of the reasons that again, I like, I like the program. Um And you know, a week, a weekend on call isn't actually so bad because you are breaking up with cases in the theater. So I wanted to talk a bit about preparing for surgical training. So after you a as I said, after you graduate from medical school, it should then be a priority to try and get a CST post. Um and everything you do sort of in work and thinking about portfolio should be to try and refine your portfolio to try and secure that, that job that you want, that top choice job that you want. And the f the key message is to try and be prepared. Um So this is something you can be prepared from now, even when you're at medical school, look at the portfolio scoring, just make yourself aware of the portfolio, the different sections of it, what you, what sort of things you need to be doing or what sort of things you will need to be doing in a couple of years time. To try and have a portfolio that's gonna give you a good chance of getting a, getting a top to try top choice job. So you can all Google this document. And that's one of the, one of my sort of key messages of the talk is, you know, at some point, whether it's tonight or this week, just have a look through the, the document for this current year's um self assessment scoring and just read through the sections. I'm gonna go through some of it now, but not in huge amount of detail, but just make yourself aware of it. It's also important to be aware that scoring changes every, every year and therefore don't try and become so bogged down with the intricacies of one point's gonna get me this or two points are gonna get me this. It's the, it's the broad domains that are important. So try and build your portfolio within the different domains of the uh of the overall scoring system. And by that, by doing that, you'll be able to build sort of a well rounded portfolio that when it, when it comes to applying. And however many years, 234 years, you'll, you'll then be looking to score in all the different sections. You might not, you know, not everyone scores are full marks and we'll get full marks in the portfolio, but you want to be be scoring something in all the different sections. It's also important to be aware that you submit your application sort of quite early into F two. So you don't actually have much time in enough to, to sort out your portfolio. You have to sort of do it a lot of it in F one and at medical school. But don't, don't be sort of afraid if, if it, if you can't get it done by, by F two, you can always take an F three. That's what I did. And I spent a lot of my F two trying to sort of pull things in for my portfolio. And, you know, I took an F three, I took an extra year. I applied during my F three and then I got, got a job uh when I, when I applied during F three and it is a game, you just have to play the game, you have to score the points where, where you need to. Um, and you just got to play the game unfortunately. So these are the different, uh these are the different domains, er, they changed them slightly this year but they're more or less the same. So these 2022 these were the ones that were traditionally every year with the same domains. Um They changed them a bit during last year but they've, but, but more or less, they're, they're the same. So commitment to specialty I is always going to be one of them. Um They got rid of postgraduate degrees and qualifications and they got rid of awards, whether they put that in. At another point, who knows, quality improvement is always going to be always going to play a part, some sort of teaching and training and teaching is always gonna play a part and then presentations and publications are always gonna play a part again. Leadership and management was previously a section, they got rid of it this year. Um But, but that's not to say that they can't add that section in, in the future. So what I, what I would suggest is something that I did again, probably a little bit late during sort of my F one F two is I then created a folder on my laptop um of all these different domains. So, and I labeled them 1 to 1 to 9. And at the beginning, the folders are empty and it makes you feel a bit rubbish cos you're, you're creating a folder and it's got nothing in it. But with time, a portfolio takes time to build and with time you add things into different things ii into these different sections. And, and when it then comes to creating a portfolio and uploading evidence, it's also more organized. So you know exactly where, where your different evidence is for all these different things. So this is something that I would suggest doing, create a folder, you can create, create oo on your laptops or a a physical folder. If you prefer to do that as well. Um And just, and just start putting evidence er in, in that folder. So commitment to specialty is probably something that's always going to going to make, make up part of the portfolio and it's something that you can start early. This is definitely a section that you can start and probably should start medical school. Um So this is, this is the exact scoring. I'm not gonna go through it too much, but there's always gonna be part that's going to say about how much operative experience you've got and how many times you've been in the theater and how many times you've assisted in the theater. And again, my probably my second key message is if there's another thing you're going to do after listening to this talk is download ee logbook and create an account if you haven't got one already and just start up uploading cases that you, that you assist in, upload them to e log book. Otherwise you're going to miss cases if you don't do this now and you and you do it at a later date and they've increased the number of cases that they, they want you to, to, to experience um to get full marks. They want 40 cases, which sounds a lot. But if you're spreading that over 34 years, it, it's not a huge, it's not a huge amount getting into theater is just something you just have to be proactive about. Um It can be daunting at first theater is always gonna be a bit of an unfamiliar environment, especially as a medical student and sometimes as an F one, just find someone friendly often that's a surgical trainee or a, or a consultant, someone you feel comfortable with and just let them sort of take, let them sort of take you under their wing and get you involved. Find out about the cases that you're going to be assisting with, try and act interested if you're interested, you've got questions, you know, you, you can have a discussion with, with the registrar or consultant, they're more likely to say, oh yeah, come and come and scrub rather than just sit at the, sit in the back and, and, and sort of be forgotten about. And I think they've actually changed the, the scoring that in those 40 cases you actually have to have assisted. So being, being interested, being engaged is only gonna get you further attending conferences again, something quite easy to do at medical school. There are loads of conferences, some of them are online um and just attending them, they can be interesting as well. There's lots of orthopedic um conferences B OA I think was this week. Um Bota which is for the trainees is, is coming up in November. Um These are good conferences to network and meet some of the other people and also they're gonna get you points on, on, on your portfolio. A surgical elective. I did a surgical elective. I thought it was probably one of the highlights of my, my, my time in medical school. It was really fun. I went to Cape Town for six weeks. Um I did surgery there had, had sort of a great holiday, but also assisted a lot in the theater and I probably assisted in 40 cases just during my, during my time in on my elective. So it's a good way to build up that operative experience and just cos it's happening abroad, it's, you can still upload it to log book courses is something that's no longer included in, in here. But again, a fun way to uh you know, show commitment and something again you can do at medical school, they may always add courses back into commitment to specialty. There are lots of different suturing courses, laparoscopic courses. If you want to do general surgery, arthroscopic courses, there are always suturing courses that are run by your, your surgical societies at, at university and just get involved. Um Again, they're fun and they, they are going to show some commitment. And then finally, Mmr MRC s part A isn't included in here. Um And that's just that it, something that you're going to have to think about during F one or F two, whether you want to sit it I II would say just sit it during F two. It's something to get out of the way if you want to do surgery anyway, you're gonna need to do it at some point, just get it done during F two. Uh, so I'll speed up a little bit cos I know I'm running out of time. So, quality improvement again, something that you can, you can get involved in quite early. Um, at medical school often you have to ii had to do a quip during my final year. So there's, there's no reason why you can't make that surgically themed and then it's gonna count towards your towards your portfolio. So it's something that you can do final year or alternatively if you, if you don't and, and it's not a good audit that you do during medical school, something that you can definitely get involved in. There's an F one, most of you will have surgical jobs in it. There's an F one. So get to start the project early during the placement, give you time to collect data, close the L reorder, close the loop cos these are all things that are going to get you maximum points in the end. Um Also just with all of the, these th th this sort of evidence, try and get a letter from uh your supervisor and that will just be your, your final sort of evidence that you can then upload as part of your part of your portfolio. That can be quite, quite straightforward to if it's a, if it's a good audit, which you know, you should always try and do a good audit, make a poster and submit it to a, to a conference conferences, have audit sections. So they usually accept a lot of different projects. You can present a poster, get a certificate and then that's also also gonna count towards your portfolio. So I just put in, put in an example of an audit. I did, I did it during my F two and I don't mean to put it in to sort of scare you and think, oh, all this work, it was quite straightforward and it got me a lot of points in my portfolio. So it was an audit on, on a uh abdominal radiographs. I did it at, at a hospital called Barnett Hospital during my F two. Then had it presented at two different conferences as a, as an abstract, as a, as a poster presented locally. So that's already sort of max maxed out my points for audit. Um and can also start to come towards post the presentations. Um You get a letter from your supervisor and just have quite distinct words in that letter. So the one that they always used to like was designed lead and implemented change. Um and that just uh you know, a acts as a um your, your sort of evidence that you've done that audit. And then if you want to take it a step further, which this is, I didn't do this before. My course, surgical training. Um application but you can then write up the order and get it published. So, had I have done this, you would have then maxed out points for, for um publications as well. So, 11 what I'm, I'm using this just because one project can go a long way and you should really try and get the most out of a particular project um before to, to try and maximize points for your, for your portfolio. I'm not gonna talk too much about presentations and publications. Um It's always gonna be in AAA section that creates a lot of anxiety. Everyone's always anxious about publications and, and presentations. Um They do require a lot of effort. Um And most people don't have any publications when they apply to co surgical training. I only had one case report. So I would have not scored mo most 1010, all the 10 points. Um Previously, they used to split these two sections, up. Posters are going to be easier than oral presentations and try to aim for generic conferences if you are gonna apply, say, you know, a, a bota College of Emergency Medicine, this is a radiology conference. They are more generic conferences rather than you know, conference for just knee hip and knee surgeons, for example. Um And then you can think about extra quips or trying to create a tr trying to turn a teaching session that you've done into a quip is also quite a, quite a good way of getting around that publications. I'm, I'm barely gonna talk about because I think they're very difficult to get, especially at medical school. You've got a lot of other things on and, you know, spending a lot of time on publications. Not, not many people do. Case reports can be quicker and easier. Um, as I said, I had a case report before I applied for a course of surgical training. That's all my public, that's all my publications were um a bit quicker to do, easier to publish, but just be aware that they will never score you. Those fuller maximum points. Teaching is something that you can get involved in quite early. Um especially as an F one, there are loads of, you know, interest for having, for having teaching courses for final year medical students of how to pass finals. And that's something that I did as an F one. There were a few of us, we all wanted to apply for course of surgical training. So none of us had a teaching course. So together we set up a course for final year medical students. Um we set up the course it was pre COVID, so it was run in person. But now since COVID, you can just run it online, um we got attendance from more than one university and got proof that there were, there were students from more than one at university. We got feedback, we got a letter and then suddenly you've then maxed out your teaching experience all for, you know, one day or, or, or a weekend's worth of work. Um As an F one, this is a new section that they've added teaching training qualifications, I think almost impossible to get because I don't know many people who had ap even APG CERT before applying for course surgical training, let alone AMA or an M SE in teaching. So this is a section I can't see people scoring particularly strongly on PG. Certs are expensive, they're time consuming. Um but they will, they will count towards every single application that that you will ever do in the future, including ST three applications again, something to be aware of and then uh just finally leadership and management. So it's not included in the portfolio anymore, but I think it's still something that you get to get involved in. It's something that you can talk about at an interview. Um and they could always add this section back in. So just I've just put a few things that, that you could do at medical school. So surgical society get involved meds. So different sports teams, they are often different reps for different years that you can get involved in. And these are, this is going to act as a, as sort of a leadership or, or a management role. And then during your foundation years, volunteered to be the best president, you know, uh BMA rep or a or an F one rep or being a rotor coordinator, all these things will count, but the caveat is, don't take too much on um because then it can be a bit bit difficult if you do. So that being said, we've talked about the portfolio, it's still gonna be the M sra that's going to shortlist. So be aware of that and, and, and sort of re revise and prepare for that. When you do come to sit in f two interview courses, the interview makes up most of your rankings. So, you know, you can boost up a AAA slightly weaker portfolio with a good interview. Um These are a couple of the, the, the, the courses that are quite good. One of the, the, the CST interview.co.uk is run by an orthopedic registrar, er in North London, someone that I've worked with before and it is a good course, I've interviewed on that course before. Um There are lots of different books. This is the book that most people use. Um This is the website that most people use. It's a very good website, it's tailored particularly towards course surgical training interviews. Um These two things are more or less all that I use for my interview. Um and then find a friend, find a colleague who's also applying and just absolutely ham a practice. Um coming up to the interview, you should be practicing every day, going through the same stations over and over and over again. Uh and it'll just become second nature. So a few final final points, my, my two key key messages are, look at that self assessment scoring early and download e log book. Um These are two things that I think, you know, you shouldn't, shouldn't wait to do and should do as soon as possible. Get involved in a few different things and try and do them well, rather than just taking loads on. As I said, you can get the most out of a particular project, um, by sort of taking it to the extremes. Uh, and it does take time to build a portfolio. So I don't think you're just gonna wake up, er, tomorrow and have, have a fully built portfolio. It's gonna take time and these things take years to develop, um, be sure to still enjoy medical school. I, you know, it's not the be all and end all. You should try and, you know, do well in your careers and try and, uh, get a, get the, get your number one choice job but do, still try and enjoy medical school. Don't take too much on and equally try and enjoy F one F one's a really good year. Um, you know, you're adjusting to life as a doctor. It's a very social year. So don't sort of, um, take too much on that. You can't enjoy, enjoy your life as an F one. the caveat to that is you, you can always take an F three and you can always use an F three to, to sort of build up your portfolio at the end and um and then get the job that you want just my email address. Um If you've got any questions, um feel free to, to email me. Cool, thanks Johnny. Um If everyone has any, if anyone has any questions, just put them in the chat down here, I've put a link to the um the self assessment scoring guidance for you guys to check out later if you want. Um Yeah. Uh One more thing I forgot to mention before we started, we are recording this session. Um We're making a website for notes and that will be uploaded. Well, when it's done and then you guys can have access to that. I, I'll put it on the group chat once it's done. Um But if no one has any questions, we'll move on to Beth. If you've got any questions, I'm still gonna be here so you can just put them in the um in the chat and I'll respond to them. All right. Thank you very much. Are we all sharing and running? Ok. Yeah. Fantastic. Ok. Um So I'm Beth Pincher. I'm a consultant working at the Northern General Hospital in Sheffield. Um My speciality is trauma and limb reconstruction and we're gonna give a bit of an overview about your career in orthopedics. So, talking through a little bit about the path all the way through training right up until the end, uh, discuss a lot of the good. I know Johnny's already mentioned many of the reasons why he went into orthopedics. Um, and I think we share a lot of similar ideas. Um, I'm also going to be very honest in this talk and talk about some of the bad things. I think the best thing you can do is go into your training with awareness and uh kind of reality of what it's going to involve. Um And then finally, we're going to discuss a bit about how to succeed different levels and also towards the end overall. Ok, it's a really important slide to begin with. This is your path from where you are now at medical school all the way through to the end. When you get your consultant job, the minimum time that most of us are talking for this is 17 years. So it is a long time. It's a big undertaking and you need to be very aware of what you should be doing at each stage. Uh Certainly they love an interview question about where do you see yourself in five years. So it's really helpful to know at what point you're gonna be entering each section when those applications are being made. And some of them as Johnny has said, are really competitive and also your exams. So at the moment as you come up to your medical school finals and then considering when you're gonna sit your MRC S, your membership exam and then almost the exit exam, the Fr CS further on. Now, when we compare that to many of our colleagues who are gonna become GPS, you can see the appeal, they finish medical school and they have five years, they do one more exam and then they are fully qualified GPS, five years after medical school. And at that stage, they're no longer doing nights, they're not doing weekends often, they're not doing evenings. So it's really about understanding your one of what you're gonna undertake really uh to pursue this career in orthopedics. Now, that being said, I'm gonna quickly go through what I did. So I'm a University of Sheffield graduate from 2010. I then took my foundation jobs in Sheffield. This is the lovely Northern General Hospital and this is the first time I encountered the circular frame fixator, which we'll come back to later on. I was very lucky, worked very hard to begin with to get into core training on my first attempt. Stayed in South Yorkshire. Great. At this time, you're getting to do some operating, you're doing basic hip fracture fixation and you really do feel like a surgeon following this. I've sat my MRC S exam. This is the gentleman with the floppy hat who we'll see again a bit later. And then I took a trip to Ellen Road. This is the lead United Football ground where they used to host the ST three interviews. It was in person national recruitment. And then there were some tears. I didn't get my ST three number. At the first time around, I didn't get into the training program. I wanted to. And for a while I was absolutely devastated that I wouldn't be able to follow the career that I wanted. So I did a year here. This is the lovely Doncaster Royal Infirmary. I took a year as a registrar working on that rotor as a trust grade before finally returning to Elm Road. And the second time around I managed to secure my training number in North Yorkshire. And here are some of the lovely hospitals that you can visit in North Yorkshire. And as you can appreciate, it's a pretty massive deanery covering miles and miles and loads of different places, but it wasn't all bad. I did some presentations. I did some more operating and then I met the guy in the floppy hat again. So this is my Fr CS my exit exam and then you move on to fellowships and that's where the frame comes back in again. So you finish your registrar training, you get your certificate of completion of training or your t and then after that, you decide what you want to specialize in which for me was trauma with limb reconstruction. So I did a year of learning how to put a circular frame on and then I went to another trauma center to do some general trauma before finally ending back where I started at the Northern General Hospital for my consultant job. Now it's a long process, we know that it's hard work. So this is the good, this is why I went to orthopedics and similar to Johnny, there is variety. So in trauma alone, you're operating all different parts of the body, all different operations. And if you want to do some elective work, you can replace knees, hips, elbows, ankles, you can fuse toes or you could be like my spinal colleagues who fuse the neck and going at the c spine from the front. It's always a very scary time. The other good thing is the people. So not only have you got a variety of patients, you treat young patients, you treat elderly patients, most of them are very grateful for everything you do. Most of them come with a good story and trauma as to how they injured and you get to meet them, work with them, make them better and follow them up. So the patients are generally absolutely fantastic. Your colleagues in orthopedics. These are happy people. So this was me on my fellowship. This is Simon Royston and Nick Denison, who were the two trauma surgeons in Sheffield at that time and they loved coming to work. They enjoyed everything about their job. And Mr Royston tells me every week now that this is definitely better than a real job. And he's absolutely right. We go out occasionally for a Christmas meal and the team are people who all want to do their job. They love orthopedics, they love treating the patients and they are just a happy bunch of people who really do, like going to work and doing what they do and similar the instant results. So like Johnny manipulating his wrist, this is an ankle ap and lateral radiograph showing a fracture with a subluxation. The patient gets some sedation. You put a back slab on an A&E and the ankle is the right shape. Again. Within 20 minutes, you've got an X ray that shows you've done a good job, you then take things to theater. So this is one of my tibia fractures from a few weeks ago. The fracture's not lined up. You can't leave it like that. So you put a frame on it and you do some magic maneuvers and eventually your fracture is perfectly reduced. And there's nothing better than that in theater knowing I've reduced the fracture. Everyone's happy all around high fives if you could. And you know, you've done a really good job and you get that X ray straight away the outcomes as well. So hip replacements are well known to be one of the most effective operations. Over 90% of patients who have a hip replace replacement are delighted and come to clinic at six weeks and tell you. So even Andy Murray had his hip resurfacing, managed to return to his competitive tennis. And even when we don't do anything, bones love to heal. Fractures often heal. If you break your clavicle, there's like a 95% chance that it will heal if you do nothing. So when David Beckham broke his foot, they did nothing. And he returned to football when Michael Owen ruptured his ACL, his anterior cruciate ligament in his knee. He returned to football with an orthopedic operation and slightly less well known. But the hip fracture patients, they come in, they're in pain. They can't even lie in the bed. They're in so much pain, you do an operation and the next day they're sat out of bed, they're mobilizing with the physios and the satisfaction and the joy that we get from doing that. That is definitely what makes the job fantastic every day, neither money. So Johnny touched on this a little bit where the private practice was something to consider. Realistically, you are not gonna have a mansion and you're not gonna have an Aston Martin. What you will have is a comfortable existence where you have a house, you can heat your home, you can buy a weekly food shop and not worry, you're not gonna be in that category of thinking well, do I eat or do I eat? We are paid reasonably well for what we do. However, I'm gonna be entirely honest when it comes to salaries this is all available on the internet. It's not some big secret. The starting salary for a consultant is 88,000 lb a year. You get a little extra for doing the on calls. But by the time you've paid the tax man and your national insurance and your pension and your parking, you are probably taking home somewhere between four and 5000 lb a month, which sounds like a lot. But when you're paying a big mortgage, it can soon disappear. If you're living down in London, the costs are incredible. So again, it's about thinking what you can afford, having said all that if you save hard work hard. One of my colleagues does drive a Porsche and I like my holidays. So over the years I've managed to travel, that's my way of switching off and see a few places here that I've been to over my training. So the pay is good, but you will not be in a mansion driving in Aston Martin. Now, the bad stuff, we have to be honest, the hours are hard. You will be doing night shifts and you will be doing night shifts for a very long time if you go into orthopedic training. So I stopped doing night shifts at the age of 36. You are resident nights if you are working in a busy trauma center and it is hard work. The other thing is the hours. So typically if you're on a trauma job. The list can run late in the evening. My standard trauma list finishes at half past seven. So that is not a short day. Our trauma meeting starts at 8 a.m. So if you're after a 9 to 5, then orthopedics is probably not the thing for you. The extras. So again, from Johnny's talk, you've all been told, you need to do audit, you need to do Q I projects, you need to be doing research and getting it published. These things are time consuming and you don't often get time within your rota to do this. So this is your readings, your weekends that you're doing these extras just to get the points for your application and the exams. We've already said there's another few before you reach the end, they are expensive. They are time consuming and you do find certainly you lose a few months of your socializing for the time just up to your exam. So be prepared and the travel. So this is the lovely North Yorkshire Deanery. A few hospitals I've selected out here where people get sent. You typically rotate around a different hospital each year and unless you have a camper van to live in, it makes life a bit difficult. Where are you gonna live? Are you gonna move every year to different rental accommodation? If you have family, where are you going to set up your house? Where are you gonna send your Children to school? It is not uncommon that my colleagues do not get home in time for bath time or bedtime and it can cause friction at home if you're working long days. And finally, we have to talk about the culture. There is no secret about all these publications that have come out very recently discussing bullying, discussing sexual harassment, surgeons being at risk of burnout and working in an NHS where a lot of patients aren't particularly happy with the system. Throughout my training, I don't feel I've been bullied. I haven't experienced sexual harassment, but it is out there. But hopefully we are moving away from this culture and things will improve. So how to succeed. Having heard all that if you still wanna do this, I would absolutely recommend it. And getting started early is the answer. So choose your electives wisely do orthopedics, do surgery, get that logbook started. So this is the E log book website. It's free to sign up. You need to make sure you go to theater, get those patients, hospital numbers and their ages and get it in your logbook to keep a record from now. Try and attend the conferences. It was the ba this week, we always have a session for medical student presentations. So while you're a medical student, you're not in a room presenting against consultants who've been doing it for years, you're in a room with other medical students presenting quality improvement projects, audits and get involved with the projects and audits. Now, when you're on placement, speak to the juniors and they will let you get involved and finally do enjoy your time at medical school. This might be the last time that you're not working shifts for many years. So, if they tell you the day is done and you can go home. Absolutely. Go home from placement. Enjoy your evenings. Enjoy your weekends. When you get to your foundation years, a lot of the time you will get taste days and that is the time where you can go to theater, you can make contact and you're showing your commitment to the specialty. Really try to get to the conferences of foundation training. You will have study leave and you can do that then and get involved with more audits. Every department you work in will have an audit lead and they can help direct you to what needs done, submit everything for presentations every time you finish an audit, just put the abstract in. You've got absolutely nothing to lose and consider sitting your part. So as Johnny said, it can be done particularly in foundation years. If you've got a job in the community, um, GP psychiatry where it's not as busy. If you've got an academic job. These are the times you can think about doing exam preparation and sitting that exam and decide on the merits of an f three year or a year out to travel. And we've touched a lot on getting into core training while you're there, you need to be organized with your portfolio, choose your list wisely, I found that going to a list with my supervisor, there was always a junior registrar there, so I didn't get to do much. I wasn't very involved. So I often went to other people's lists who had very senior trainees and therefore I'd be able to do a lot more of the basic operating. Go on the relevant courses. You wanna learn how to put plaster cast on. I know Bradford runs an excellent casting course. And the basic orthopedic courses were mentioned, work on your publications and presentations and plan your next step. So it's all about understanding the criteria for your next application and then overall understand what the final job will look like. So being an F one, you kind of get an idea of what it's like on the wards, you don't understand what it's like at the end and it might take you all those years to get there, but you will be a consultant for 20 to 30 years to understand what the final job will look like. And is that something that you want to do long term? Speak to the consultants? Most of them are more than happy to share what their job plan is, what it involves, working in trauma centers versus working in the district, general hospitals, find what you love doing. So, orthopedics is great, you can do delicate hand surgery, complex, foot and ankle surgery. You can replace hips and knees day after day and have really happy patients. You can do trauma and get the variety. There is generally something for everyone but you need to love what you do. You do not want to wake up every morning and think I don't want to go to work because that is no way to get through a career in the NHS. You've got to love what you do and enjoy going to work if you don't succeed the first time, keep trying. There's very few people I know who've gone straight from foundation years to core training to ge to the fellowship. They wanted to the consultant job they wanted. There's always gonna be hurdles and it will feel like, you know, you've been set back, but keep trying. If it's something you want to do, try and maintain a good work life balance and learn how to switch off. So whether that be going on holidays, like I love my travel, whether that be going for a run after work, whatever it is, find what makes you balanced and what helps you turn off from work. Keep a good support network. So family, friends, work colleagues, whoever it is you can talk to when you need to unload and finally remember that this is a marathon, not a sprint. So beware of burnout, you can't go 100 and 10% for 17 years. It, it just doesn't work. So take time whether that be time out, whether that be realizing it might take an extra year, but don't burn out. Thank you very much. Happy to take any questions as well. All right, bye. Uh Do you wanna put their questions in the chart if they have anything? And I put my light on one. Yes. All the time. Fine. We also had a, we promised you guys some certificates for coming to this um talk and we have certificates for the rest of the talks as well. So here's the feedback form. It'll be amazing for the two talk speakers we have today. Um Oh, we do have a question uh from Salma. Hi, thanks for the talk. Just wondering what your general working week, like the working week is like as a consultant. Uh So my job being trauma, I work in one of the major trauma centers. Um because of the nature of my job, I don't do much in the way of routine elective work. Um Part of the uh contract with the hospital. I work at all. The consultants have what they call a NON NHS Day. Um So for me, that is a Wednesday. That is a day where you're not contracted to work for the NHS. So some of my colleagues are in the private sector. Um People who do trauma often take on me legal work in their spare time. Um So normally a Monday is my on call day. So I'll have a list either in the morning or the afternoon, depending on which week it is. And I do an on call one every four Mondays. So a normal Monday when I'm not on call, go to work and do some operating and then I have some admin time in the afternoon. On a Tuesday, I run a fracture clinic in the morning and in the afternoon I have a semielective list. So again, more operating and the bulk of that is either for patients who've had fractures who haven't united or have not united correctly. And those are more planned cases on a Tuesday, Wednesday, as I say is my NON NHS day. So I don't go to work. Uh Thursdays is my day for limb reconstruction. So we have a morning meeting where we discuss all our patients waiting operations, the ones who've had operations and then go to the ward and review any inpatients who are either awaiting surgery or had surgery. And then in the afternoon, we have our limb reconstruction clinic. So I see any patients who need a frame or have a frame on or need a frame off. And then Friday again is generally operating. So I share the trauma list on a Friday all day with my other trauma colleagues. So normally kind of every other week or one in three weeks. I have an all day list and otherwise on a Friday, I've got time for teaching the uh registrars. Um I have time for personal development. So we all get sessions in the week for keeping up to date, making sure our mandatory training is done. Uh So Fridays, it's either full day operating or day for teaching and uh my own portfolio development. Sadly, the portfolio never stops. So throughout training, you have an online portfolio and even as a consultant, we have re validation every year. So it always continues. You've always got to keep up with your paperwork. Um Because of where I work, there's 16 of us on the on call rota. So one in every 16, I work a Saturday, Sunday weekend and then another weekend I work Friday into the Saturday. Nice thing as a consultant when I finish my job, kind of my operating at eight o'clock when I'm on call, I get to leave the hospital. I'm available. I come back if anything needs doing overnight, if any patients are unwell and need to go to the theater, but generally when you leave the hospital, you are on call, but you don't have to be there. Unlike the registrar who is still there on a resident night shift. Mhm. Ok. Another question if there's a special work or especially with charities, if we can do that in orthopedics, sorry, you cut out a little bit. What's the point about if we could set up for working abroad with charities? So it's quite loud here. Now, all of a sudden, um, if you look at the chart um underneath my link, there's the questions, you sound good normal. Last Tues. Uh Is there an orthopedic specialty which is good for working abroad, especially with charities? Um, definitely trauma, um, is a very good place to be with that. Um The other thing I'd say was probably pediatrics. So there's lots of pediatric surgeons who go out to do orthopedic pediatric work in uh the developed countries. There's a lot more issues with congenital deformity. Um A lot more work out there for pediatric orthopods. So they go out quite frequently. Um Africa, South Africa, um and again with trauma, um it's quite common to go abroad and do your elective somewhere that has a lot more trauma than we do. And the charities are very grateful for anyone who can go out and do similar work. Um There are definitely if you Google orthopedic charities who go to different countries, whether that be because there's been a natural disaster or because there's war or other ones who just go out to provide the service that's not kind of supported by their own health service. So, absolutely. Um, there's a lady called Depa Bos who's one of the consultant trauma and reconstruction surgeons in Birmingham and she's quite heavily involved with charity work abroad with orthopedics. This one might be good for you for the portfolio courses. Is there a time limit for your cases? Like if you're in a second year? Medical school? Is it too early to be applying for putting cases down? No, there's, as far as I'm, I'm aware there, there's no time limit. So it's all, um, when you apply it, how many have you got at that point? So, one of the reasons why just start early, if you're in the second year and you're already assisting in theater, then, you know, start logging them in your, in your log book. They, they did change it slightly that um when I applied, you didn't actually have to be assisting, but they've changed it. So you actually have to be assisting in theater. Um But there's no time limit. So just start, start early, um and get, get logging them. Cool. Thank you. Um Beth one for you, is there a pathway to specialize in sports injuries? And if there is, is there sort of an overlap between orthopedics and sports medicine? Um, definitely no subspecialty of sports injuries alone. Um, often depending on which bit of orthopedics you go into, you can have a bit more of an overlap, but to actually do kind of sports injuries, sports medicine. As far as I'm aware, it is a separate entity. Um, a lot of our colleagues do, the, the subspecialty would be referred to a soft tissue knee and that will cover your knee injury. So your ACL ruptures your knee ligaments. Um Having said that one of my colleagues who did foot and ankle was involved in a lot of the ankle sports injuries. So, unfortunately, it's more a case of you either do trauma and operate everywhere on broken things or you pick a body part and sports injuries are part of that. Um, but within orthopedic training itself, there's no real clear pathway into sports injuries. There is a separate thing called sports medicine or I understand they do treat a lot of sports injuries, but I'm not sure how that ever feeds actually into being a surgeon and the surgical side of it. So I think it's either sports medicine and you look at them and their rehab and the physio side of things or you go into the surgery with orthopedics and depending on your body part you operate on sports injuries. Um, but yeah, it's not clear within us. You don't get a placement in sports injuries and fellowships for that. I'm not sure are well, kind of known about for orthopedics. Thank you, Johnny. What counts as assisting in theater? Got a question. I mean, I would say that if you're, if you're scrubbed, you're assisting, if you're holding retractor, holding suction, you're, you're assisting. Yeah, I mean, I, I've been assisting and it's honestly, it's just doing anything that gets you involved and not like if you're like 2 m back and you're watching, you're not really assisting if you're just in there, even if you've got the gloves on. Um, yeah, standing there, you could say that's assisting. To be honest. Yeah, get scrubbed in, get your hands somewhere, get someone to hand you a retractor offer to say, oh, you know, would you like me to suction the blood anything? Say definitely get involved. You can cut suture ends. You're not gonna do any damage in orthopedics. It's all good for you. Definitely come ask to get scrubbed in and most of the time they'll let you do something that resembles assisting enough for you to put it in your logbook. Um We have a lack of opportunity in accessing TN. Um Where would you recommend looking into for exposure if we can't get access to it in medical? Yeah, I mean, I know it's really difficult. So Sheffield University now do not have a orthopedic placement. You do not get sent to orthopedics routinely. So if you're lucky enough that one of your generic placements early on is orthopedics great, but you have no control over that. So our medical students have the same problem here. Um The only real option is your electives, your students, elective components, whatever they're called. Um So at the moment, our uh kind of third years who've just gone out on the wards, they get to pick taste days and things. So I often have medical students who are on diabetes, respiratory for eight weeks. They come to me for a day and come to theater and scrub in and that's always good for them to get involved, see what's involved with that. Um, but also when you go through and you get to pick whether that be your elective, like Johnny said, he went away for his elective and had really great orthopedic experience or whether it's even just a student selective component, anything you can pick, um, where you've got flexibility, um, get in touch with people. They generally don't mind if you've got named consultants who are there for orthopedics. If any of them have given you lectures, if you've got very well with kind of junior doctors, ask them who's approachable and you can often get yourself a placement in orthopedics. Other than that, the only time available following medical school is going to be your F three year. So again, control over jobs in foundation is hard and there's no guarantee you can get an elective, um, sorry, an orthopedic job by choice in your foundation. Yeah. So if, if you really feel you've, you've not tried it, you've not had that experience and that's where an F three year could be really valuable. Thank you. I think that's the next question about Eiden assisting in surgery. So how, how would we go about evn it? Do we need a letter from our supervisor every single time? No. So you just, you just upload your logbook, uh have a record in your logbook and then when it comes to applying um to core surgical training, you print out your log book and you get your supervisor at that time to sign it and validate it and then that counts as a validated logbook. It's really difficult with patient confidentiality. So years gone by, if you were involved in an operation, you'd get your name on the operation note and you'd ask them to print off a spare copy or photocopy or whatever it might be. So, you have got hard evidence that you've been there. However, the idea of taking patient recognizable data out of the hospital for you to keep in a, a port polio somewhere and it, it's very tricky now. So I think getting the logbook done as you go when you finished a placement, ask your supervisor print it off then and there get them to sign it. So even if it's multiple pages of the logbook, at least you know them signing it, it then validating it that yes, you have been involved in those cases and the, the information for the log book is just um the hospital number, the age of the patient, what the operation was and where it was performed, sometimes it asks things like, was it emergency? What was the patient's ASA grade? So, were they fit and well, and it doesn't make too much difference. You can generally gauge that, you know, if they're a fit and well young person or is the anesthetist very touchy because they're very unwell. But the important bits are just fill it in. Get your hospital number and your age and what it was that you were doing and that, that's what matters. Yes, you can if you assist on surgeries abroad. So I did my uh my elective in Cape Town and I logged all of the cases that I did on my elective everywhere. Will have some kind of patient reference number like here. So everyone has an NHS number in England here. Most of them also have a patient identifier number which is slightly different and normally shorter. It doesn't matter which one of them you put in the logbook. Um, but I'm guessing it's exactly the same abroad, there will be something to identify that patient. Yeah, definitely. And just going back to that, that lot, that previous question about, uh, TN O experience. So when you, when you rank your, your F one and F two jobs, there are loads of different jobs available and if you're interested in orthopedics, try and rank the jobs with orthopedics in them, people that don't want to do surgery and don't want to do orthopedics tend to avoid those jobs. So, you know, if you have a bit of an interest in orthopedics and think, oh, is this something that I want to do down the line then, then do a job in orthopedics and that's one way of finding out. And, um, now with the changes with oral as well, how we don't get our E PM results, it's just sort of generating numbers for F one F two. You have a really good chance of actually getting what you want. Um Well, the same chance as anyone else to be honest. So competitive, things like trauma orthopedics. If it is competitive, then you have a good chance of getting them as well. So I would, I would make sure to fill them out. You have to remember for every one of you who wants to do orthopedics as your colleagues who really don't want to do orthopedics. They want to go into general practice. They've heard there's a bad name to it and they won't want to do those jobs if they can help it. So actually, you know, there's a reasonable chance of getting them and if all else fails, you should all have some kind of option of taste today in your foundation training to be able to go and see some orthopedics. All right. Um Thank you guys so much for doing this talk for us. Thank you everyone for coming to the talk. Um We have the feedback form, I'll put it, put it in again. Um It would be great if you could fill it out. So we got some feedback for the speakers and for us as well as an organization. Um But yeah, like I said, it's the first talk of 10. Hopefully we'll see you guys in the next, I'll just put my email address in the chart. If anyone's got any questions they want to email. Um but yeah, thanks guys.