Computer generated transcript

Warning!
The following transcript was generated automatically from the content and has not been checked or corrected manually.

Hello, everyone. My name is Claire Pritchard. I'm a GI. You training working in the northwest of England. Thank you very much for bearing with us when we had a little bit of a technical delay at the start. Um, two medals, great in some ways, but I think it can be a little bit tricky. Also, Um, my colleague Emma is just sorting out sharing all the slides. Um, as we go along today, people please feel free to ask me questions as you go along, put them in the chat and at the end of every speaker, we will try to respond to questions just while we're sorting out slides. I'm just going to go through what we're going to cover today, so I'm going to chat. First of all, I'm going to talk about application process and interview timelines and building your CV. My colleague Doctor Cannon is going to talk about dual training with general internal medicine because I'm sure as a lot of you know, that's changed in the last year or so. And then Doctor Benedict holdin is going to talk about a day in the life of a consultant and doctor mucus or bang is going to talk us through a day in the life of registrar. And as I said, please feel free to chat as we go along. Thank you. I can see the slides now. Thanks. And, uh um, you can go to next slide. So we've gone through all of this. This is our program for today. Um, I'm going to kick off. So I thought I'd start a little bit about what we do in sexual health and HIV, also known as genital urinary medicine. So a big part of our day to day job is the diagnosis and management of complex actual health conditions. We also provide HIV care. So everything from diagnosis to treatment, management of complications and assisting patients with CO morbidities unrelated to HIV provide contraception. And sometimes in some quite complex situations as well. We'll take an active role in public health. Outpatient specialty. Predominantly the focus of that will be changing a little bit with the combination of general internal medicine. Um, and it can depend on whether you're working in a smaller clinic or in a clinic associated with a big teaching hospital. I think one of the best things about sexual health is that we get to work with people that many different stages of their lives. So from the time they first become sexually active or just before up until you know the later stages of their life. And that can be support with menopause care, safe sexual health in in later life as well. And then lots of people, specialized or sub, specialize in, uh, area such as genital dermatology, psycho sexual medicine, sexual assault care, transgender healthcare, uh, and many, many more. So it's a really varied, diverse specialty. Next slide, please. Uh, thanks. So this is the structure of the training. You start off with your foundation training just two years. Then there's a selection process to recruit into either internal medicine, which used to be called core medical training. That's now a three year general medical training specialty. The other route is via a ccs So acute common kids, um um and and that is by the internal medicine branch of A CC s. And that's a four year program. The next election stage is into G u um, registrar training. You have to have passed M R C e p Part one and two before entering into registrar training. That is four years, so from ST four to S. T. Seven and there are two exams to sit during that time. Diploma and gum and diploma in HIV leading TFCC next, like eczema, I thought I'd just share a little bit about one of the characteristics that we're looking for in future gum doctors. So excellent communication skills. Someone who's non judgmental, not easily embarrassed, someone who's adaptable and resilient because there have been a lot of changes in sexual health in the last 10 plus years. Someone who enjoys working as part of a team. And I've added in someone who's got a strong sense of justice because often can feel like we're really battling to do the very best for our patients. The link at the bottom here is the full person specification from the recruitment website for genital urinary medicine that goes into exactly what we want and some deniable characteristics as well. Next life is over. Thank you. So one question I had when I was preparing this presentation from somebody who's interested in gum is water, but I d What about community sexual reproductive health? I've broken it down into the different areas. So gum, As I said, it's a four year specialty. It's entered through AM I M T or a CCS? You dual credit with General Internal Medicine, and we cover the areas listed here. I've already talked about the examinations I. D. So infectious diseases is a five year specialty. The first two of those years is core infection training where you rotate between, um, I d Micro Biology. Um, and then you go onto subspecializes in the area that you want to do so you might be wanting to be a virologist with, you know, some covering of I d. Again that's post I m. T or post a CCS internal medicine. You can choose to do a credit with general internal medicine, but you don't have to. You can get a dual CCT in, for example, microbiology or I. D. And general Medicines are quite varied, and they do a combination of clinical and laboratory medicine with the focus on infections. As the name suggests, they do have HIV exposure, but not as much as in genital urinary medicine and very limited sexual health care. They're examination is fr see path and the combined infection certificate exam and then finally combines, uh, community sexual and reproductive health. So that's a six year post foundation training program. You don't need to do any core medical training or horrible. And Janie, there's no dual accreditation, so you just have a C C t. So that's your consultant job in sexual reproductive health, and they focus on complex contraception, pregnancy care. They do ultrasound, scanning gum, Um, and no HIV care. And the complete examination is the, um, FSH for that. Okay, next time, please. Uh, so this is the recruitment timeline for registrar recruitment. So the mid November is when specialty adverts are published. Then the application period goes up until the second week of December. Then there's a period where everything goes a bit quiet because applicants are being short and long listed. I put the exact dates from this year's recruitment round, but evidence was uploaded between the 10th and the 17th of January, and then the interviews this year were March 2022 with offers being sent out in the third week of April. So I'm thinking, if you're thinking about planning an application in the next couple of years, it's quite a useful slide to have a look at next. Like December. I'm just going through a little bit of application scoring. So in our last recruitment event, we talked a bit more about you know why you want to do gum Good. And the bad things about gum. Um, and this one, we're focusing a little bit more about people who are thinking about applying, getting ready to start applying, Um, and how you can really boost your TV in your application at the top. We've got undergraduate, postgraduate and additional achievements. I've separated those because they're essentially fixed. You can't change your undergraduate marks. The additional achievements is around, you know. Did you get a distinction or is that medical school and postgraduate obviously could go and do a PhD or masters. But often people have either got that or they haven't by the time they apply for ST three s before, as it will be, the presentation's The top marks for this is first also oral presentation at a national or international level. But get some point you can do a poster at the national or regional meeting. Um, just to get top point is that you have to do that. One is listed there. Publications wise again. Top Marks is first author on two meds. Related articles teaching you get top marks. Having organized and taught on a program for more than three months. I think this is quite achievable. You know, if you're in foundation or if you're in I m t you could arrange to be part of the teaching. Um, you know, uh, organization kind of committee Put together the teaching program for a few months, do some teaching sessions on it. It's certainly doable. And then quality improvement. You get top marks for involvement in all aspects of to quality improvement. Project. Again. I think you could easily get that done by the time of applications. That doesn't have to be sexual health related. Those quality improvement that can be. You know, anything that you've done this improved practice in your area of work and then finally, leadership. So top marks for national or regional leadership roles for more than six months and again you can. You don't have to be medical leadership roles. First of all, you know, if you've done something non medical that can still be relevant, and there are less marks, other leadership roles that may be slightly less prominent. Thanks for the next slide. So this is the breakdown of the interview. There are four scenarios or four stations. The first would be an ethical scenario. The second would be clinical scenario, so those would both be related to the gum rather than related to general medicine. So, for example, for my ethical scenario in my what was S t three interview, I was asked what I would do about the patient living with HIV who worked in the medical field. Um, and I didn't have any great knowledge about you know what I need to do at that point of view and just sort of talk things through, um, a sensible manner and passed that station easily. You know, you don't have to have the exact guidelines off Pat, you know, that's what they're training you to do. They just want to know that you're a thoughtful person that can think through a problem. Clinical scenarios wise, I had a patient who is newly diagnosed with HIV, presenting with shortness of breath and the case with TB. The medical registrar suitability is new in the last couple of years, Um, and this is focusing on the non clinical aspects of being a medical registrar. So how you manage make you take how you manage a busy outpatient department? And then finally, there's a presentation, which is entitled, Why I'm interested in a Career in genital urinary medicine and what evidence you have. You prepare that in advance, and that's your time to really sell yourself as well as all of these domains you marked on communication skills throughout. Next slide, please. Mm. So this is just a bit about how you can build your CV, how you can get some exposure to go and decide whether that's really what you want to do. The courses and conferences There's the ST I Foundation course or the stiff course. Those are running all around the country, Um, and there are a real good introduction to come, so you get a mixture of lectures, tutorials, online learning, and you get a certification. At the end of that. There are courses coming up this year. I think there's one in Belfast and one in Blackpool, and the other courses coming up next year as well. You can attend the bash conference or the Beaver Conference, and the Bash conference, at least has a reduced in the summer, had a reduced rate for non training doctors and medical students to attend. There's the national gum taste today, which has just passed in earlier in October this year. And that's an annual thing. And then you can come and attend stash education evenings, which are once a month. And they're often I'm really interesting topics, which is slightly different to you. Know what you might have learned in medical school in grand rounds or that kind of thing. Uh, next is societies associations. You can become a member of Bash. I should say exactly what bashes so bashes the British Association for Sexual Health and HIV, And that's our kind of guidelines. Um, a lot more network for the UK It's free for students to join, and it's 40 lbs annually for foundation and I M T trainees. So not too pricey at all. You can get involved in stash, so that's a that's a student and trainees association of sexual health and HIV, and they do mentorship education improvement, and we have a project arm as well. At the bottom, I've just put so the faculty of sexual and reproductive health do have an affiliate membership. If you really wanted to join that and the HIV Trainees Association, although I don't think you can join if you're not a registrar, you can take part in education offense through them, and then we've got projects, so we a stash have a project arm. You can also find a local project mentor. I think often you know, people are really busy and, you know, sometimes don't have already made project for you to do. There are simple and effective things that you can do, which will boost your CV, get you some exposure to see you and show initiative as well. So some examples of come up with If you're on respiratory, you could do a quality improvement project about testing for pneumonia. Test doing an HIV test for patients that present with pneumonia, which is an indicator condition, a condition where a HIV test would be indicated. If you're a foundation trainee rotating through urology or absent Janey, you could do, um, you know, felt improvement project on ST I testing in pelvic inflammatory disease or epididymo orchitis or if you're not kind of working in anywhere where you think you're going to get any Q. I PS done Clinically, you could do a survey of your colleagues about their confidence in history taking sexual history, taking do a teaching session, make interactive and then survey them again afterwards. And finally, um, so teaching. So get involved in foundational I m t teaching teach on something that you're interested in. Have a look at the rash guidelines and do a teaching session on the committee or less something like that. You could choose, um, an article from the ST I BMJ sexually transmitted infections journal. Um, and we call that a journal club. Or if you've got an interesting case on the ward presented ground round, there's loads of things where you're applying this year. Whether you're thinking about applying in the next, you know, 3 to 5 years of loads of things you can do to build your CV. I think that's the end of my presentation. So I'm just gonna have a look at the messages because I can see that we've got a couple of questions. So we've got from the pasta to these achievements have to be within the last 12 months before applying or at any time Does it include medical school to Fortesta. Having had a look at all of the scoring of the last couple of days, it doesn't have to be limited to a certain time. Uh, these achievements can be at any time and then thank you from that page. Who's, um, HIV and sexual health trainee that you can join as non registrar? I did think that, but they haven't updated their Web site map, so that's why I didn't include it. Any other questions about this section at all perfect. I'll hand over to Luke. So Luke is a sexual health trainee, um, combined with with a general internal medicine working in the Northwest. And he's also the doctors in training rep for Bash. I'm so sorry. I just answer a quick question from Neulasta before handing over to you. Look so you. Because you said so. If I've held a regional leadership role in medical school, that's okay for portfolio. Yes, that's absolutely fine. So it's specifically says you've held a regional leadership role and you can demonstrate impact in that role. It doesn't there's no time limit on it at all. So the medical school be completely appropriate. Okay. I wanted to sleep. Cool. Thanks, Claire. My slides have changed because of our technical difficulties. So they're all like, jazzy and lovely, and now they look a little bit bland. So if there's bits and pieces that are out, think it's the technology's fault and not hours. So I'm only going to talk about 55 minutes or so about doing general internal medicine within your gum training. I'll be able to go to the next slide, please. That's okay. Marvelous. Right. So this is a relatively new change for gum and some other specialties, including palliative care and neurology. With more general medicine, specialty is likely to follow. Um, and essentially, they think really that we ought to be attributing to general medicine as HIV and, uh, and gum are deemed to be, um, kind of physician, really is the word that they use but physician least, uh, specialties that contain a lot of general medicine. So as much as the sexual health side can be quite specialist and aspects of HIV can be quite specialist, we deal day today with a lot of general issues in our HIV uh, cohort, Both inpatient and outpatient. Next five, please. Great. So what does this mean, then? In the real world for training. So, um, those that are pre I m t into the medical training, Uh, may not know that I m t is three years and that's your old kind of, uh, kind of senior house officer s h O. Training in old money where you rotate through your different medical specialties usually every 4 to 6 months. And one of the extra changes recently and I m t is the is the addition of doing I see you for three months Also during your training, the idea of your final years and I m t Yeah, I m t three is that you take on a bit of a junior registrar roll when you're on call and when you're on the ward. So certainly, at the moment I'm on my medical block. Um, at the end of my training and the i m t three with us on call tend to take a lot of the A and the referrals and will help lead some cardiac arrests just to get some experience so that when they become a medical registrar the following training year. The jump isn't so much. So within going, UM, we would do 25% of the training year in general medicine, so that's three months, and most sense is kind of still working out how they're training's do it. And it's different two different sites, but the vast majority of people are doing a block of medicine, so I'm doing a block at the moment. So I'm on a general medical wards doing on call medical shifts but also doing one HIV clinic a week so that you still kind of keep your hand in in your in your kind of specialist area, and you will have an educational supervisor both income and in medicine. Um, who can support you through completing your portfolio and making sure you're up to date with all the bits and pieces that you need to do. So I think there's there's a slide next on, but I think you can probably skip that. This is a little bit old. This is just talking about the way that they were kind of looking at how you fit your GI. I am blocks into your government training, but to be honest. I think it's a little bit obsolete, and it really depends. I was saying on the hospital and the trust that you're working in, Um so which pattern suits you the best. So we would probably skip on from that one, if that's okay. Okay, So that being said with these three months blocks, um, when you're doing your gun training, you'll do some inpatient HIV work. Or depending on where, what, reading urine and what hospital there are. You may do some infectious disease is on call, and this will contribute to your internal medicine. I am there your internal medicine competencies. So you may be able to do three months less of those four year, three months blocks if that makes sense. Uh, but again, that's location dependent. And may you know, there isn't one rule for everybody. So it would be unfair of me to kind of give you, you know, a definite answer. At this stage, the DFS Rh is a diploma. In fact, your sexual and reproductive health, and really, in short, is your core contraception knowledge. Um, that you do during your training, and that extends to doing your coil and your implant and surgeon. Now, because of the introduction of the I am training into come, they've made that non mandatory. But in all honesty, um, the vast majority of consultant jobs and would expect a gun consultant to be able to insert a coil, um, and an implant. So as much as it is, um, any kind of, you know, non mandatory We would probably expect everyone would do that. Uh, and there is a new government curriculum, and the new format of that, as alongside lots of other medical specialties, is far less kick boxing. I think we're all used to and we kind of having to see so many patients with this or see this presentation and take that off and go to the clinic because you haven't done any aspiration. And and that's that's starting to fade into the background now, uh, and and they're they're looking at, um, kind of competencies in practice that they're calling them that group a lot of skills together, rather than a multitude of take boxes that you have to do So that's coming in August. And as someone that's got that curriculum now in my portfolio, it's a lot more user friendly than the previous ones, but that's a positive. Okay, were able to move on. Okay. And that's come out a little bit small, but my experience in general medicine, I mean, I've I've done lots of general stuff in the past. I did call medical training and then did some, um, sometime over in Australia for six months doing general medicine. I did some time after foundation. We got redeployed doing coverted. Uh, and I did some general medical stuff in my S t five year. And I think what I would say is that second point in bold is that being a medical registrar really is not as scary as it sounds. You learn so much on every shift that you're on, you have a leadership position. People look to you, but they look to you for knowledge. But we all know that we it's impossible to know everything about everything. And you have a hierarchy on top of you with your consultants on call. There's there's where I am. There's a second registrar on call as well. So if I'm given, um, or if I come up against something that I'm struggling with, I can just call my friend, uh, an actual adviser. I can call the consultant. It really isn't as scary as people think, and that includes hours of hours work as well. I think every job is busy, and I think it's I think Claire and I would both say that when you move from being a dental medical doctor and with sick patients in the hospital and then you move into gum, your world bit different. It's an outpatient setting. But instead of doing a war down with a consultant every day, you're seeing a quote of patients in the morning in your clinic and there your responsibility to see them. So every job is busy. You have to do your letters and make sure that you're managing your results and things. So it's a different kind of busy, Uh, and I think from my experience as well on the Ward's so many people are really interested in what we do with that. There's not many of us out there as when they ask, You know what, what, what background? I'm in. Um, you know, it always provokes questions, and then we can provide specialist input, and I'm not even making this up. You think I'm making this up for this talk tonight. There's, um, an inpatient to my general medical wards who is a new diagnosis of HIV at the moment. And so I can give, you know, some input to the juniors and to the ward rounds there, as well as the gum team coming in every day or so to see them. I don't think three months out of 12 months is that long. To be honest, I'm coming to the end of a three month block that I started in August, and it's gone incredibly quickly. Um, so really, I don't think that we should see that as a burden to your training. It's another string to your bo. That means that when you come out the other end, you can help on the general medical take as well as, um, staying within the government HIV department. And that has a bit of, you know, kind of variety to your medical experience. But also that bottom point is extremely important. Not all consultant jobs may demand GM involvement, especially if you're working perhaps in a smaller department in a smaller hospital. Maybe that there isn't any opportunity there isn't time to do the A M because you've got a small staff. So I think the thought that you're just gonna get roped into doing a lot of acute general medicine on call isn't entirely true. But of course, there will be some hospitals where they where they would look favorably upon that. And you might be able to do the A M reward round or ambulatory ambulatory care session built built into your job plan. So I think that was mainly it. I think the last slide had some Twitter links with a spelling mistake anticipated. Oh, that's That's not how that slides looked. So that's a bit awful. I will put some of the some of the twitter tags of bash and beaver and stuff in the chat so that you can, uh, so that you can find them and follow them. And I'll put the link for that Rough Guide to Do Medicine, which is up to date from the J A R C E P T B Web site. Marvelous. Thanks. So that's all I have to say. I don't know if there are many questions. I can see one or maybe one coming in Yes, Thanks, Luke. So Cecilia said. Now there's G AM gum, dual training. When you complete training and go into a consultant post, are you expected to work as a Gen Med consultant for a certain percentage of the year as well as in gum? Or you Could you choose to work solely in gum? Yeah, I think. I mean, there's I mean, I think that question probably came in as I was mentioning that. So, yeah, job plans are, and I'm going to link that in that question, that's just come through about consultant post starting to reflect the I am. There's there. There are some of us. They're nearing the end of training that have done general medicine prior to the introduction of the new curriculum this year. Out of choice, really, I I didn't choose that. I it wasn't forced upon me to do it myself and some other colleagues around the country have decided to do it, and we're kind of coming towards the end of our training and then we'll talk about job plans. Nationally, there is a move. This is a bigger picture. There was a move, Um, in this in this in this country to create specialists again that come and do general medicine rather than creating super specialist. A good example of whom, for example, is cardiology at the moment who really trying to steer away from general medicine? And I think that that has become less acceptable, Uh, that they're they're they're making people that are specializing in a general medical speciality and, you know, partake and seeing patients at the front end of the hospital because they haven't they, you know, they have experience and insights that there is a benefit from that front end, So I don't know anybody. I don't know any specific job plans, And I know that for example, there's a there's a consultant, a new consultant who I used to work with as a red who's a rheumatologist on the ward next to me. And he is doing something along the lines of, um, like a block or so a month or so covering award and then going back to his rheumatology day job. So I wonder whether that might be something. One possibility, um, of a job plan that will develop others may just be that you do you join the on core medical rotor, Um, and that one weekend in, you know, eight or something, or maybe even fewer. You do award round on. Am you on a Saturday or Sunday? And so that's what I would expect it to be. Certainly, I don't think you would be pulled out of government HIV for a long period of time. I think you would expect it to be. That would be the bulk of your work, and you would be dipping into general medicine. I think that's what I would say to that. You got any other questions coming through? If you think of anything more towards the end, I'm around so we can answer them. But I think that's everything. Thank you very much. Luke. Thanks for that presentation. We're having some ongoing technical difficulties related to meddle Platform. So our next two speakers haven't being able to join the stage. Uh uh Is that something that you could help with? Because Benedict is one of our next speakers. Is able to watch the presentations, but can't join the stage to speak. Um, and Dorcas, who is also joining us. I've invited her to stage, but she's not appearing. Maybe I could help Or maybe you could help answer this question from Africa. Uh, so how do you find work? Life balance is a trainee. It's not a basic question at all. Lucky still here. Yeah, Yeah. I mean, I think I think that, you know, I think most, most specialties have there, you know, kind of stresses and parts of the specialty that you don't enjoy. I think that that that's every job around the world. I think the perception of gum, I think, um, and the other specialties like dermatology, for example, is that the work life balance, um, you know, is good. And there's a reason why people have chosen to go into that specialty most what? What they don't tell you is that most medical specialties will have an on call, you know, kind of aspect to it. So, for example, I know other you know, other other speakers later, we'll we'll come on to this. We we are on call in gum. So, for example, we would do a 24 hour on call by phone, um, one day during the week, and then you'll be on call during the weekend, where you have to go into a war drowned, and you'd be expected to answer your phone for the whole weekend So people would argue that that's different, obviously, to running around the hospital. You know, doing 12 hour shifts for general medicine on call. But I think, you know, a 9 to 5. And medicine doesn't really exist. And and on top of all of the roles that your clinical rolls, you'll have roles in management and leadership and perhaps education. Um, which you know can add add add to your, you know, interest. But maybe also add to the time you spend. But I think we're all in the world, aren't we? Where colitis tortoise That we value our spare time more than you know. We have had it before. And but yes, being a little bit crass, I guess there isn't. There isn't such thing as a 9 to 5. The medicine. Um, but some specialties are are more kind of on the ground than others, I think. Thanks, Luke. Don't want you want to answer this question from Tunisia. What are the points of gum that you'd say you don't enjoy? Mm. I'm going to talk about I think Really I mean, I was thinking about it while you were talking. I think I think I think I go on. I mean, it's it's a little bit of peace, but I guess, um, that the transition from looking after acutely sick patients on the ward's as kind of what we've all what we've all done. We're doing our training to sitting in a clinic where patients are well and actually where patients may not have anything wrong with them at all. And they want just some, you know, reassurance. Um, I found that a challenge to begin with, and I don't think it's something that I don't enjoy, but sometimes accepting that. Perhaps there isn't anything going on, and that reassurance is needed can be quite difficult to wrestle with in our minds. And all we've done is to look after sick patients. Um, I think one of the things I struggle with on an unrelated note and it goes back to kind of the activism, I guess that Claire was talking about maybe is, um, some of the access issues that that people have throughout the country with sexual health and, you know, funding for sexual health has been cut and cut and cut. But the demands for the service has risen. Uh, and and so we don't like not being able to see people government, an unusual specialty And that you you want people to come in. Um, whereas another medical specialties, you're trying to keep them out. You know, you're you're you're trying to prevent prevent people coming in with my eyes and things. But you were actively encouraging people to come in and get tested. Um, but because of cuts to, uh, funding, it means that we can't see as many as we'd like to see. Uh, and that can be quite frustrating. I think Claire would agree. Definitely. Sometimes it feels like, you know, that you have walk in clinics every day and still not managed to meet the demand and can absolutely, absolutely be frustrating when you know you're potentially missing people who are high risk people who are really symptomatic. Um, yeah, I think there's a really good point. Thank you. Um, today she just said again, What do active roles in public health looks like? Um, so there are lots of different ways to get involved in public health. There is a bash educational fellowship which is a yearlong, um, sorry. Fellowship in public health is a yearlong program where you're linked to kind of a team of public health team and you're taking part in or you're leading a project. So one of my friends has done a project on there for less among heterosexual people in the UK Luke and I are are attending a meeting next week, which is a big public health meeting about sexual health in the Northwest, and that's shared by one of the consultants in the Northwest. So there's lots of different ways to get involved with that. But equally day, day to day, we get involved in public health, you know, with a notification of infections like shigella, um, notifying, um, labs or acting with labs to action, gonorrhea, resistance, all that kind of thing as well as obviously, public the public health implications of HIV testing and treatment. So there's lots there, and then Selma, we'll come back to your chart your question later, if that's okay, because the doctor Benedict Holden's just managed to join us, so I'll hand over to him now, thank you very much better, and I can only apologize for the technical issues. I'm feeling a judge after doctor kind of mentioned old money, and then I've singularly failed to log on to this new platform. I'm feeling like the old person on the call, right? What's one of my normal days? Um, just going back to what Luke said Busy, different. And when you get to a consultant, it's about all the other extra bits and pieces that you might add into your career so you can get involved much more in management. So things that I would do, um, previously being a divisional lead. So taking on responsibility for service delivery budgets, um, and then other things that that that you can do, um, in the organization that you work for. So I'm an appraiser, which means that I've got five plus doctors that the tire praise throughout the year so that that's something extra. And also, I'm I'm a union rep. So I sit on the local negotiating committee, which is the the interface between the doctors as a group and and the trust management. So that's in a way where you're going over the policy and protocol which might apply to to the medics and also liaising with the with the other, the other groups in the trust So so the nursing leads. So there are lots of things that you can do as well as your normal day to day job. So I suppose one of the things is, um, how contracts change. So in a previous job I worked down in London up until 2019, my job description was split between six DCC direct clinical care and for, um, s p A. So supporting professional activity. So I had more managerial responsibilities. I did less clinics. Um, the job I had done in London. I did quite a lot of dermatology. So every other week I did a specialist multidisciplinary dermatology clinic, either with gynecology, obviously dermatology, urology. So you had that interface working with other other specialties, other consultants, which was actually quite a quite a fun morning. Um, and my current post in Blackpool is a little bit more at the whole face, so I'm 7.5 direct clinical care, and that's mostly, um, mostly GI. Um, so walk in or just booked, G, um, people calling up with the problem. So you don't know what you're going to get in on the day. They're all new attendances. So at the moment we're seeing a lot more syphilis. Certainly in in Blackpool, which is quite interesting. Is something in the medical school I was told we wouldn't see much of. But we see quite a bit of in the Northwest, um, so and I do two HIV clinics a week, which are actually mostly I'm doing very little face to face. So with HIV, most of the patients are stable. That that that's a phone consult bit challenging when you're taking over a cohort of patients that you've never met and you're dealing with them all over the phone. But you know that that's something that we've all had to get used to with with co vid new patients will come in for a face to face people with problems or wanting to see somebody in the flesh will come in face to face. So we are. We are slightly going back, I, I suppose, to more normal methods of of delivery, and it is good to get to know patients. That's the one thing about HIV is it's different to come. You have a cohort of patients. I have my patients that I look after. Um, obviously, in a new job, you're getting to know people, but then people that I'll anticipate getting to know over the next four or five years and and and being their main point of contact with with with the medical profession So sure, we look after their HIV, But we're also looking after the general health. We're giving them advice on smoking cessation and alcohol. Um, if they're drinking a bit too much BP, liaising with general practice to make sure that all of these extra things that we might be picking up and looking at are being appropriately dealt with. So so again, a normal a normal working day could be very different, depending on who comes into clinic. What? What? What I'm doing in in a way. But but again, one of the other good things about about sexual health we we, our our patient based I do one long day, so Monday work until half past seven. That means I get Thursday mornings off every week. We do do HIV on call, um, black ball. We we have an ID consultant, but we do normally have one or two in patients. So again, liaising once a week about if you've got an impatient at that time, you'll be liaising with I d. I'm not part of the general medical rotation. I must admit, I don't know any colleagues yet people that I've trained with, I suppose my advanced state of years, et cetera, who are doing general internal medicine. I mean, for me, I think it will be quite a challenge. Although I did a lot of general medicine in my training training, did a medical rotation in Scotland. Did Med Ridge there again? You get out of the habit of these things. So I must admit, if all of a sudden I was expected to do a medical on call, post take wardrobe and I would find that quite challenging. Have to wait and see if that if that is, if that does develop as part of the role, especially with I suppose, more shortages of consultant staff and and the need for um to to to cover and the expectation of when people will have a consultant review that that might be something that that that that that's coming down the line. But again, if if our roles and responsibilities change. The NHS is very good at making sure that we're all appropriately trained to take on those responsibilities. Just checking my time. I've I've gone over my allocated 10 minutes, but more than happy to to take questions. Thanks very much, Ben. Um, so there are a couple of questions. I think one of them you would be really well posed to answer. So Alexander has asked, What does the geographical spread of job post for gum look like? For example, are the majority based in bigger cities? Yes, it's just the way that I suppose clinics and services are set up. I mean, black black holes quite interesting because we're a hub and spokesmodels. So we we we do have community services in different, different localities. So I don't know if anybody's who's familiar with the Northwest, but we've We've got Blackpool and then further south, down the coast, we've got Lytham, and we've got Kirk bit more inland so that the black pool service provides like a hub and spoke model. But the consultants are central. Um I mean, yes, there are so many big clinics in London. Um, a lot of that there are a lot of training posts in London. People want to go to London because there's HIV inpatient care as well. Um, you know, there are at least Chelsea Westminster University College. Um, uh, the Royal London that there are at least four or five different centers that provide HIV in patient care and HIV on call, which is important for training. But if you if you wanted a job in a rural clinic, Wales, I live somewhere nice and rural and driving to Blackpool. It's very nice place to live, but yes, I think I think most of your training is going to be big city. There's the lakes as well. The lake district rooting for consultants. Um, down South is Devon, Cornwall. That will have clinics. Um, but yeah, definitely. Big city based for a lot of your training. Thank you very much then. That's really helpful. Very helpful for me as well as I come to the end of my training, we've got a few more questions on the chat, but I think I'm going to hand over to our final speaker, Dorcas. Oh, bang. Um, to talk about day in the life of the registrar and then We'll come back to those questions at the end. Thank you very much, Ben. Thanks to focus. Hi. Sorry. Can everyone here Me? I just managed to turn the microphone on. I think I'm a bit of a technophobe. You think it's okay? Um so thanks for inviting me to speak. Um, so I'm going to just talk very briefly, um, which is probably quite difficult for me because I do like to go on a bit about what it's like working as a GI you registrar. I'm currently and s t four g. U registrar in the Northwest, and I'm commenting on my medical placement, but I've just done a year in Guiyu. So I'll tell you very briefly about the kind of cases that I come across those kind of things we do a bit like what Doctor holdin said earlier today. It's very, very, very. Which is part of the reason why I wanted to do come in the first place. So I don't think I've quite had any one day. That's been the same as the next. But I just talked to a few kind of typical case we see in our clinics. So most of what I did last year was outpatient because the hospital that I worked in, I had an inpatient service of infectious diseases which managed most of the inpatient HIV. Um, well, most of the patients living with HIV, they were in the hospital at the time, But other GI services will manage their in patients is just the way our our our set up was so we can talk about. I can talk about that if people want questions about that. But most of what we talk about is sort of the outpatient side of things. So typical day would be an eight o'clock start, and we have an integrated sexual health clinic. Um, so the things that you'd often see would be managing people who presented with symptoms of her sexually transmitted infection or had been a contact with somebody who had been diagnosed with a sexually transmitted infection and need a treatment. Um, so they could be bacterial SDI, So chlamydia, gonorrhea, syphilis, And, um, I was working a lot during the monkey pox outbreak. Sure, if we've spoken a lot of that monkey pox or not already today, but that was some sort of, uh, it wasn't a new disease. But it was a disease that hadn't been seen in the UK before, so and it's spread quite rapidly. And do you manage that as well? So that was quite interesting just seeing how you manage. And initially it was a high consequence infectious disease. So we're wearing the hazmat suits everyone was wearing at the beginning of covert and managing the outbreak alongside everything else was challenging, but also quite bizarrely fun. I thought so. So one of the things that I really love about gi you is that I think it's one of the few specialties that you can see a patient take a history, examine them, do your investigation so you can do microscopy on the day and tell the patient a provisional diagnosis them and then and treat them all in one session doesn't always work out like that, but that can be done. And I think it's a little bit like I say and the for the for the genitals. And I also think I really enjoy the kind of patient communication side of things. So one of my favorite that sounds a bit sadistic. One of my favorite kind of presentations is, um, the first presentation of herpes virus because people are in a lot of pain there really fearful. And there's a lot of kind of stigma attached to herpes, because a lot of people think that it's something that you know that they hear that they will not be able to get rid of it. They're worried about how they're going to tell you partners about it. They're worried about how it affects pregnancy, for example, and future relationships. And so there's so much counseling and good education and good kind of health promotion that you can do in that one. So, like communication and helping them manage future outbreaks that they do have future outbreak. So I just think there's just so much that can you can make a lot of impact. I think quite often people think the US not really sexy medicine. So you're not like getting, you know, a stent in somebody who's coming with A C s or, you know, drilling a borehole. Is that what it's called? Is concerned, uh, neurosurgeon. But, you know, doing a thing back to being or something like that, but actually being able to tell somebody a very simple diagnosis which will change the outlook on things and being able to reassure somebody that they're going to be okay, I think is is pretty amazing. So I enjoy all of that. And so that's usually sort of what happens. Also papered inside the kind of integrated, um, sexual health clinic. Well, I think I don't know if you've spoken already about Prep and Pep, but we'll see people who have been may have been exposed to HIV within the last 72 hours, always as an emergency in our clinics. And we'll give that post exposure prophylaxis. And we also we also prescribe and counsel patients on pre exposure prophylaxis for HIV as well. Um, so that's quite a lot of our work load, actually, um, at the moment and then we'll have, uh, contraception clinic. So a lot of that is done virtually so. We'll counsel our patients. So if somebody wants an implant or coil inserted, and I think it works quite well, and that will have a sort of counseling consultation virtually over the phone explaining what will happen when they come, I'm explaining the risks and benefits, explaining the different options the patient will pick which kind of contraception that one. And then they'll come in on the day and they'll be like an implant clinic where somebody will do just implant after implant or they'll insert the coils. And so I think that works quite well as well. Um, and I just think, um, as well as seeing, you know, straightforward patients who just need management and counseling. You also see patients who might have been sexually assaulted. You might see patients who, uh, I think with the right word who are immigrants in the UK So we see quite a few people who, um, English isn't their first language. And that can be quite difficult taking sort of, um, sexual history, which is quite a personal thing, I think through an interpreter, so that can be challenging as well. And seeing a lot of young people in clinic there can be safe guarding um, concerns as well. Or sometimes when we have to manage, we have to talk to safeguarding about certain people. Um, so that's the sort of integrated sexual health type things that we see, And then in the HIV clinic, I would sort of say that your patients who are living with HIV are usually in sort of three broad categories, so they're usually either The sort of stable patients who manage their medications really well may have had the limitation for quite a long time. And they'll come to the clinic every six months and they'll take their medications. They usually don't have any issues, and they just want to get out of clinic as soon as possible. And but it's quite nice to see them regularly brought up a good rapport with them. And I quite like that kind of, um, that's a contrast of the patients that you've not seen before, who you're managing quite quickly and acutely and being able to build the poor people and their families over a long period of time. So that's the sort of first type of subset of patients, and then you might have the patients who are becoming a bit more co morbid. So they're dealing with other medical problems. So kidney problems and heart problems and things that means that they're medications might need to be tweaked slight slightly or, um, specialist way, and then the third sort of patient is, um maybe patients who are the new. So they're quite complex. Quite a lot of investigations, and I can sometimes happen. Um, oftentimes, patients who are newly diagnosed, uh, unwell at the beginning, and that can be as an inpatient, or the patients who are finding it difficult to manage their HIV, whether that's because of mental health or drugs and alcohol or other things that are going on with their life stigma. Um, and sometimes they become disengaged. And we have really good services, like HIV specialist nurses and other members of the team who helped to try and re engage them in lots of different ways. And so, um, it can be quite varied being a HIV clinic and different services work in different ways. So some people have very specialist different clinics like HIV and joint HIV Renal clinic, or join the HIV and the pregnancy clinic. Where is the where I was working? We saw saw everybody all in one, and probably because we didn't have we didn't have an HIV specialist nurse, and we only have one consultant work in there. But that worked quite well for me, seeing all of that at that time. Really. Um, and the last thing really I was going to say was just that, um while G u is quite it's really quite a specialist, Um, and specialty a bit that I kind of I think I've already lots of things that I really enjoy that it, But I feel like you kind of have quite a few different hats on. So you sometimes have to be a bit of a dermatologist investigating whether or not you think someone could have a malignancy and genital sort of malignancy. You have to sometimes like a microbiologist when you're thinking about different antibiotics and antibiotic resistance. And sometimes you're thinking about like a gynecologist, and sometimes you've got your kind of public health hat on, and that's I think, what we'll have to do a bit of the monkey pox outbreak. And we have this interface with all these different specialties. So we speak quite often with the urologist, don't me, and we speak, um, quite often with all these different specialties and I, as you can tell, like a chat. So it's quite nice to have that interface of all the different specialties. And even though we're very self specialist, I think we, um what's the word. We integrate well with a lot of other specialties as well, and I enjoy that so we can come on now. I feel like I've gone over my time. I tried hard. Thank you so much because I'm definitely giving that A and E for the genitals catchphrase. That's my favorite. Have any questions? And you hang on. There's a couple of questions that will go back to, um so someone So Elizabeth has asked. I had a question about trans healthcare. There seems to be a horrible rising transfer at the moment. Have you noticed your patient populations being affected by this at all? Totally agree with you, Elizabeth? Um, do would you like to comment on that? Or I'm happy to share something in my personal experience. The patients that I've, I think people who have been trying to come in to clinic, I think have found the GI you clinics quite a bit of a safe haven. And actually, I don't think I've not heard anything negative that maybe that's because they're coming for a specific need. And we've been managing that. So I don't know whether or not you've, um, touched on. Now what I totally agree with you that we can be a bit of a safe haven. But I still think there's work to do within sexual health. So we've recently updated our sexual health systems to change gender and sex. And that's confused. A lot of the nursing staff and which is kind of highlighted to me, that actually, maybe I'm living in a bit of a bubble where everyone knows about pronouns and knows about the differences between sex and gender. And I think even amongst our colleagues, there's education. I've definitely had chats with people who have been Ms Gendered in the main hospital. Um, so I think in health, there's a lot of work to do. We're trying our best, and I think it needs to be led by patient groups as well. So that answer your question to Elizabeth. Hopefully, I'll just go back to Selma's question as well. So, um, Salma says you mentioned you can train to do a training I d. And, um, how does that work? So I just want to clarify. You can't do all train an idea and go. I'm sorry. I misspoke. So gum is a separate specialty, and then I D you can do it in combination with biology, Microbiology or General, listen, is that right? Because you've just done a year on Well, yeah. So I think to make things more confusing in, um, in some hospitals, I d We'll look after the inpatient HIV and some hospitals. G you will look after the inpatient HIV. So in the hospital that I worked in because I d was I de existed and I d was looking after patients living with HIV. Um, you were in patients. I had an attachment to i d for six months, but I wasn't an i d e slash g You training because that doesn't exist. I was achy, you trainee. He was doing a placement and I d so that I could get experience in in patient HIV. Does that make any sense? I think our final question, which is bang on 7. 30 is from Fortesta. How do the coated pandemic affect your work? And are there any lasting consequences? Good or bad of it? I feel like I have spoken a lot. Does anyone else want to weigh in and or Luke? Yeah, I'm here. I don't mind taking it very quickly. Yeah. So I think when at the height of coated, everything happened very quickly and genuinely, services were being changed. You know, almost daily there were new updates about how we should do things. And, um, you know, whether it's virtual who came in to see us, I think one of the main areas, it's kind of it's kind of, uh, kind of brought an issue to front and center is the HIV care that was already kind of beginning to go down more of a virtual route. Uh, and I think that coated kind of brought that forward a bit. So we have a dog. He was mentioning some of those stable HIV patients who come every six months. You know, people were realizing Do they really need to come and see a doctor or nurse every six months? Um, you know, have the bloods and etcetera. So, um, some some clinics are even doing 12 monthly reviews. What we do in our clinic, for example, with stable patients, is that they have an annual review and then in six months, they come and get their bloodstream, and they go home again without seeing anybody. Uh, and one of the doctors or, you know, the nurses go through their blood and make sure everything is okay and just send them a text. Um, I think one of the negatives of coated surrounds access again on the generative on the gum side of things, we we were able we were seeing less patients. Um, and there was a move towards kind of postal kits which worked quite well. But there are some people that, um, that just need to be seen sometimes. Uh, and postal kids are fantastic if you're asymptomatic and you just want to double check because you're not tested for a while. But if you've got some symptoms or you've got some concerns, you know, like some of the patients are talking we're talking about, you need to get in and see someone. Um, So I think maybe I'm talking a little bit out a little bit out of turn. I think one of the negatives is that, um, some, some some people will quite like the idea of virtual reviews. I think the majority of doctors, especially on sexual health side quite happy to see people face to face. And I think we should try and encourage that and and, you know, new clinics burning up everywhere. We've mentioned that trans stuff. There's transit clinic, um, now in Manchester in Liverpool and following in the footsteps of Brightened and London. Um, and I think we kind of need to go a little bit away from Mass kind of, you know, kind of virtual reviews and try and see people that need to see a small face to face. I would totally agree with that, Luke having seen someone today who just popped in for their blood's appointment and mentioned that you had a non healing bruise when I examined him. He's got at least four different composers. Sarcoma, lesions. Um, I'm all for continuing to see people face to face as much as possible when they need to be seen. Does anyone have any final questions before we wrap up today? Just wait a couple of minutes. People to type. It doesn't look like there are any more questions, So I just want to say thank you so much everyone for coming and thank you to our speaker's and thank you for people bearing with the technical difficulties as well. If anyone wants to get further involved in stash or has any questions for any of us. Um, you can contact us via Twitter via Instagram and I think by email as well. Thank you. Everyone will be asking for feedback. We always want to improve things. Um, yeah. Thanks again. Bye. For now. Yeah.