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Hi, Gareth. I'm just there for others to join them in. Know baller out. Just give everybody we met up there to get in. I'll just go ahead and introduce, you know. And so our next speaker is Doctor Gareth Gamble, and he is an S t seven and anesthetics and also an intensive care medicine program. Um, so, Gareth, you're really welcome. And, uh, the floor is yours. Thank you very much. So, as I said, I'm ST seven Anesthetics and intensive care. Dual training. Um, So what sort of two specialties talk about? So what I hope to talk about is good, bad and the ugly of NSX intensive care training, Um, so even more intensive care on its own and then move some questions at the end. Just about a pathways in and what not. So I was looking to Shawn's talk earlier in anaesthetics, and I agree with that. I love my job. Good points. Um, it is so highly variable. The largest, a inpatient specialty. So that's everything from pre op surgery to then doing the surgery? Well, our anything for surgery, whether that's general surgery, cardiac surgery, neurosurgery, um, then post operatively and acute peeing issues. There's resource and trauma calls in the emergency department. There's labor ward for analgesia and also for the anesthesia for sections, chronic pain and intensive care, the list goes on. Um, it's a really highly supervised specialty. Initially, Um, that means you get supervised doing procedures till you're really, really good at them. Um, and then able to practice independently, um, compared to some other specialist, whereas bit more have ago approach to procedures. Um, like, even putting a cannula in from the start, you'll be it'll be intensely scrutinized. But that's how you get good at things. Um, it's a practical specialty. So there are all those tubes lines, nerve blocks, spinal epidurals. There's lots of practical procedures to do, but it's also what I like the very reactive specialty. So you give a drug and the heart rate goes up or you give a drug in the G. C. S lowers. Um, it's not that it changes your lifetime risk by 2%. It's very direct and immediate. The stuff you do, um, some of the bad bits that don't really bother me, but it is quite an invisible specialty. If you take, I'd say half the general population. No idea what underneath it does. Could be half of my extended family. Also don't know what I do. Um, not quite sure if you're a doctor at all. Um and and part of that comes from the fact that if somebody's going for an operation, they know that Ms Brown or Mr Smith's doing it, they don't really know where. Care who the anesthetist is. Um, and that's because there's a complex relationship. Without surgery, there'd be no point for an anesthetic, but without an anesthetic, you can't have the surgery. Um Anethe This are also involved in a lot of traumatic things. So most of the traumatic things that happen in the hospital Anita, this is somewhere in the middle of it. Whether that's a resuscitation, whether that's trauma called the emergency department, whether it's a maternal or a pediatric disaster, um, so it can be quite traumatic at times thinking about the ugly. By this, I mean the sort of myths people have about the specialty. So the first myth is that well, any honest easiest for those who can't really communicate or can only communicate with someone who's asleep, I'd argue, and maybe five minutes. Preoperatively. You have to convince somebody that they trust you enough that you're going to make them unconscious, paralyze them, take over their breathing and BP and bring them back to the way they were and make them pain free after an operation. Likewise, in Labor Ward, somebody's in distress during labor. You have to convince them to sit still enough for you to put a big needle in their back. So you really do need good communication skills. Um, again, there's a perception that it's all sitting around drinking coffee. And while there is a lot of drinking coffee or tea or whatever, your choices, um, at night particularly you could be covering all sorts of aspects of the hospital Here in Craigavon Hospital, I think I've been on every War department. You name it at some point in my anesthetic career. Um, finally, there is that perception that it's all technology. There's no real human touch. It was There is a lot of science's to it. There is also an art anaesthetics, and it's important to say that there's a both art and science to it. The sort of final myth which sort of links into the next pit. Is that anesthetics and intensive care? The same thing and they're not. Was you a lot of intensive care during your anesthesia training? And actually, intensive care is where a lot of people come to from doing a foundation program. A Rhoda in it, they're actually very different. Most anesthetic consultants don't do intensive care. Um, was in the Northern Ireland. Most intensive care consultants have an anesthetic background. You can also people here from an E D background from an acute medicine background, a renal or respiratory. And some people who do that is just they're sold specialty. Um, intensive care also has a lot of myths around it. We sort of have a perception that it's just lots of machines. Actually, communication comes back into it community. You know, the most important procedure you may do is a discussion with a family or discussion with a patient and their family. Um, it also is it's very multidisciplinary. Um, so between the bedside nurse who knows that patient better than anybody else, um, two physios dieticians, the full gambit of the MDT team, but also then the input from lots of different specialty because it tends to be. When people get very, very sick, they don't go second, one organ. It goes in every organ. So we do cross between all the different organs. Um, it might sound a bit trite, but they're only are two specialties of care in their name. One is palliative care and the other is intensive care. And that's because there is so much communication. And there has to be a recognition process, both in who we admit dicey, um that some people won't benefit from intensive care. Um, but also that we pick up the patient who, despite maximal medical therapy, is dying and recognize that and you know, are able to explore that then with the family. So the key skills you need to have for intensive care our communication, communication, communication, um, decision making skills because they are difficult decisions. Um, if you say to someone that the patient's not for intensive care, that may well mean that the patient does not survive, but then the decisions within intensive care And then again, that recognition of end of life in terms of training pathways, um, anesthetics actually come in from post foundation program intensive care. You come in at sort of CT to level, and you can play any time after that, having been in either anaesthetics emergency medicine or, um, internal medicine. And it generally ads somewhere between 18 months to whatever that partner specialty is. Um, in terms of suggestions, if you're interested, I would say Definitely do Taster Week, both in anesthetics or intensive care. And and there are post F two jobs in the Rotatory Hospital intensive care, um, that are very popular, giving people a sort of initial feel of intensive care and or anaesthetics for those who haven't experienced us. Um, I'm happy to take any questions that anyone has. There's no current questions in the chat box yet. If anybody has any questions, we've only got about a minute left. Here we go. Are there any clinical fellowship clinical fellow jobs, basically. And I see an anesthetic for post FDA. So there are a number of them, particularly the Royal Victoria Hospital intensive care. There are lots, and there are also trauma fellows in the royal, which sort of covers a bit more broader, but they also have sessions in intensive care. Um, and then again locally, if you've done an F two jobs, there may be additional posts. Um, if you've done F two in a hospital somewhere in intensive care there, there might be bespoke ones that can be made. Thank you for answering that carrot, Claire. Thank you. Um, yeah. That's also, uh we want to get a few seconds left, Cara. So just to thank you very much for your for your input there and for giving up your time to talk to us today, Um, and thank you. You've answered basically, every I see an anesthetic career question because nobody has any further questions. Um, so thank you very much for your time. Thanks. Thank you. And if everybody wants to just go back to the main stage now, I just, uh