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I think it's just loading. Okay? And I think we're like, So, um, good evening, everyone. Thanks so much for attending into the next installment in the mind the BLEEP Careers series. So we've had a bit of a short break whilst recruiting a new set of speakers and should hopefully have quite a few interesting and different talks being delivered by very specially specialties over the next few weeks. So pleased to keep an eye on the newsletters if you subscribe to them the mindedly or onto the Facebook page. So today's talk is on Histopathology and is being delivered by Dr Tam Be a carol. So histopathologic it one of the more different and relatively unknown specialties. Which is why we thought it would be a really great specialty to have on and learn more about. So without further a do doctor tamboura Cool. All right, well, thanks. Everyone who's registered and wants to, you know, a little bit more about his pathology. Uh, I was just talking to was seen before this, and I think it's something that you don't often get a lot of exposure to, Uh, sometimes a medical school at all a little bit and then, I think, as a doctor, Definitely not. So it might be something that's for you Might not, but hopefully I can give you a bit of a broad overview what it involves. Uh, and as you can see from my slide, I promise it's not boring. Um, right. So first, So personally, when I was a most student, I thought, this is literally all it was. Uh, you just look down on my soap all day when I was in final year. Well, when I was in first year, remember, they showed us histology, and it just looked like loads of pink blobs. And I was like, I just don't understand and I literally didn't encounter it from there on in. But hopefully after this talk, I can prove to you that this isn't actually the entire job. I'll admit it's part of it. But it's not so if we start with Histopathology itself, so it's literally the study of tissue if you should try to look it up, but actually it's a lot more than that. So I think when you're in med school, your 1st 2nd year and someone shows you like I don't know anything it does just look like pink blobs. You have nothing to go off, and I can see what I've been Pretty boring. However, once you pass through med school and then your foundation use it becomes a lot more interesting. The way I'd summarize it is that you're you're kind of You're the ultimate detective. So as as doctors we diagnose. But as a histopathologist, you are like the pinnacle of diagnosis because you have the path of physiology. Uh, quite a lot more than potentially other conditions. But it comes with the job. You'll understand the clinical history and examination. So you still form your differentials, as you would if you're clerking. You'll start developing some small expertise in radiology, endoscopy and things as well. So things were often your samples come from which I think is kind of cool, uh, often, uh, you know, obviously not as great as radiologists. You are, by far the experts, and then the bottom four bullet points. That's where when specimens come to us, this is your bit as the histopathologist. So you've got microscopy, which is basically just a fancy term for like, the entire specimen. What pathology can you see with your like, naked eye because that's what helps you, then in microscopy. So if you've got an appendix that's burst, you need to know microscopically. I'm gonna cut that bit and then look at it under the microscope. And then, obviously, microscopy helps give you diagnosis, but you still have two extra tools under your belt to help you get the diagnosis. One is, um, you know, histochemistry, which without going into too much detail, you can basically Stena slide. If it's got the antigen there, it will light up like a Christmas tree. And we also have molecular pathology, which is something it's quite knew that I'll come to a bit later, and it's kind of a rapidly evolving but long story short. Histopathology is basically a pure diagnostic specialty, but the pinnacle of diagnostics because you have all these things so kind of like I've done on the photo. It's like solving a puzzle, and that's what really attracted to me. You just get to kind of work through the diagnosis, give it help the care of a patient. But you kind of get to move on, so think about it as it's pure diagnostic, So treatment for example, is quite important to you. It's something to consider with the specialty. So next is psychology. So this is something. When I was on the wards myself, you kind of, you know, you said you sent some fluid off for cytology, and I just never really knew what that meant. I just kind of read the report after, of course now know what this means? This also comes under history pathology, which I don't think many people realize. Long story short, it's a study of cells. So as you can see from the photo, it's actually the nuclear I the cytoplasm, and that's what you're looking at, and it can look quite pretty. At least I think it looks pretty. Uh, it's all fluid that comes from any patient. So lumps, bumps, cervical smear as well, bronchial brushing for lung cancer. So it's just more to give you an idea. It's not always the pink blobs. Sometimes it's multicolored blocks, but it's really interesting in that. So what I love about this is the sheer variety, so it can come from anywhere. So, like the other day, I can look I can, like, diagnose the lymphoma. I can diagnose a benign cyst and then I can diagnose, like, full on malignancy of the thyroid like papillary carcinoma, follicular variant, all within, like, three slides. So I'd say the main takeaway from this is that you still get some variety on top of the diagnostics earlier, Uh, and then I mentioned molecular pathology. So this this gets quite complicated and even at my level don't fully understand everything yet, but it's basically this is where medicine is going off to. So you have your molecular markers. So after you've done any staining and things like that, your job is the HISTOPATHOLOGIST is give as much detail as you can about the diagnosis to other clinicians who can help treat it in the best way. So it might be that it helps you diagnose things, gives an idea of prognosis, uh, and then targeting treatment. I think the most obvious case, uh, people might be aware of is her two positive cases, and you can treat people with Herceptin. Uh, and it's something that I think is actually quite interesting in that when you think about medicine evolving, this is actually where the future is heading. So I think it's quite exciting to be part of it. Albeit it is extremely complicated at the moment. But if you're interested in things like genetics and this might be something for you, as in the future, I definitely think it's something Histopathologist will play a big role in. OK, cut up. So this is something I had absolutely no clue was part of Histopathology before my taste a week, but it makes quite obvious sense. So when you spend when you send a biopsy or literally anything that you cut away from a patient, it comes to Histopathology and they have to prepare it into blocks. So, as I mentioned before, what can you see with your naked eye? That is the problem. Cut it out, then put it in blocks so we can look at it under the microscope, which is. Actually, it's actually really fun because you know, you'll never get to see that much pathology in one go and so many different types of specimen. So it's kind of like, at least for me personally, you kind of get the most interesting bits, and I don't have to kind of just lumber on one specimen. So today I saw appendices, gall bladders, Skin's colonic polyps, like all just within one session. So if you're someone is quite practical, this could be quite enjoyable as well. Uh, we have quite a lot of trainees, actually. That kind of used to be surgical trainees and then become histopathologist. And I used to not really understand why, but then I think I see it from this point of view. It's actually, you know, quite fun, quite practical. So it's not again, you know, purely looking down the microscope. But it is really interesting, I would honestly say which is probably a testament to university, though I've learned more about dermatology in the last three months, and I think I ever have, uh, as a clinician because it just used to confuse me. But now I get to see kind of all the interesting things, right. Okay. So, postmortems. So again, this is something I don't think is well advertised, that it's part of Histopathology. Uh, so it's called post mortems or autopsy. You're there to answer one question, which is what is the cause of death? So that's when the coroner would be asking you, uh, just to know I haven't put on the slide. This doesn't involve forensic pathology. So, like, you know, murders things like that. The the stuff you kind of see on TV, that is a whole separate specialty. Um, we see kind of patient's. You might have died at home. You don't know where they died in hospital. You're not sure the cause either. It is. I I do think it is quite interesting because you get to literally again. You're being that detective and solving the puzzle. And you get to see pathology like you're literally see, like loads of fluid in the lungs. You'll actually see like pulmonary emboli. And then if you go and then look in the legs, you'll see the DVT as well. And you've got the cause of death. But, you know, understand this isn't for everybody. And and, you know, post mortem autopsy can be quite distressing. Um, it is optional after ST, too, and I'll admit, I don't really think I've met many people that have carried on after the second year. You only have to do 20 each year, so when you think about, there's like 52 weeks in a year, and you only have to do 20. It's not that bad and you don't have to. They changed the guidance. Now you don't have to be like quite so in there. As long as you can do the pathological correlation. It's enough so but it is something to be aware of. If it's something that's like an absolute no, you can't deal with it, even if it's for the two years, it's probably something to consider, but it's not as bad as you think. And I promise mortuary staff to really interesting. So okay, so then a little bit about onto the roles. Why do you think the majority of trainees, Dropout PM uh, I think it's honestly because of the just the ugly nature of it. So you are okay, maybe let me just explain what a post mortem is just in the off chance Nobody knows. I'm sure everybody does, but you get a patient and then you will open them up, fully, eviscerates all the organs, then dissect each organ bit by bit to find out what the pathology is. So I think most people just honestly just don't like that aspect of it. And when you get onto higher training, you can get decomposed bodies as well. Which, as you can imagine is, is not the best kind of visually wise smell wise. All these things, it's just something people don't find very pleasant. So that's why I think you know not Not everybody is kind of up for that in higher training. It's still interesting. But it does happen because, for example, some some elderly patient's aren't. You know, it's usually neighbors who say that we haven't seen them in, like, a couple of weeks, and then bodies can be found you compose. But just to say, as trainees, you wouldn't be expected to do decomposed bodies in ST one or two. So you know. But that's the reason, because when you'd be a consultant, you would. I have to answer this question, Um, so just going on a bit to the roles of a histopathologist so more a consultant levels are definitely not our level at trainees. Um, I think one thing I underestimated is how integral Histo pathologists are to the team. But it makes sense when you think about the journey of a patient, you're not gonna get anywhere unless you have the diagnosis. So they actually aid multiple decisions because all the information histopathologist can provide from the case. So first of all, you know, what is it? Because if it's if it's not cancer, a whole separate pathway. If it is cancer, what's the characteristics? What's the prognosis? How aggressive is it? All these things really help other clinicians. Such as Do we get chemo? Do we do surgery like, is it metastasized? What are those metastases? What? What should we do? So there is a significant responsibility that comes with that. And actually, consultants will spend quite a lot of the time in the week attending these M D. T s. So they are very important. And it's not something I think I realized before, but it does give you a sense of you are still integral to the whole kind of patient journey, even if you're not necessarily patient. Basic. Uh, so this slide don't worry about too much about the detail, but it's just to give you an example of what an on call is like for a histopathologist. So this is in the day, Uh, this is something that's done at my hospital. So it's called Mohs surgery. Long story short patient has cancer, usually squamous or basil Um, skin cancer. The clinician will cut away layers of the cancer depending where it is, they'll freeze it, send it to the histopathologist, will look at it instantly under the microscope and tell you at a microscopic level. Is this is there still cancer there or not? Because, of course, to the naked eye, it might look like it's all out but a microscopic level. You may still see malignant cells, and basically through the day, you know, patient's come and they just keep going until microscopically, there's no cancer, which I thought when I learned about this was was amazing for patient's because you get minimal invasive surgery, you know, scars and things. But you can say to a patient a microscopic level, it's all out. But yeah, So the main point from this slide, I guess, from his pathology point of view, is this is what an uncle shift might be like. So you'll be doing your case is like other things like that. You wouldn't have an MD tea, but then you might have someone popping I/O just to give you kind of slides and things like that okay and then frozen sections. So it's similar to what I said before. But it's not just dermatology, uh, again Dorabella detail, but the inter operative samples. It's something where the surgeons looked at something and thought, I need to know now a little bit about what it is, because it's not gonna give you as best detail as, for example, a sample that's fixing formula in would. But whatever it is now will make a difference, too. What do later? So again, this is an example of an on call shift, uh, at my hospital. It doesn't tend to to happen. You don't really, really get that much. I imagine. In tertiary centers, this may happen more often. So, for example, uh, there's a known tumor, and they want to know while they're doing the surgery. Is it clear or not? So I know. In London, for example, there's a there's like a speaker on the side of the theater, which goes straight down to the pathologist underneath the theater. Uh, and they'll just they'll just keep sending the samples until the pathologist is like, Yeah, margins are clear. You can finish the surgery, which again is quite cool but doesn't happen anywhere, but just gives you an idea of extra responsibilities you may have in the day and then just a quick note. So, actually, despite the fact they've talked about microscopes, digital pathology is is literally almost hear, like my hospitals going to roll it out, Maybe December, January. So instead of using microscopes will all use computers like massive screens. So it's similar to how radiologists have transitioned from, you know, when they used to put the radiographs up with light and they now use computers. Uh, which is gonna be really cool because then you can share cases you know, globally. It helps people in other countries as well, because diagnostics is one of the main reasons for health inequalities in other places. It also allows remote working, though, which I thought might be important for some people's personal circumstances. Uh, just a short note, uh, artificial intelligence, interestingly, is something that's going to be kind of incorporated into our work, which I think will be interesting. It's a bit of a controversial subject at the moment, but it is already in use and leads as well. But don't let anyone tell you it's going to take over our jobs because trust me, it won't. You know, I don't know. Anyone's like used e prescribing and you try to change paracetamol from oral to IV, and it, like, throws a schtrops. So I don't think we'll get there anytime soon. Okay, So a short bit about subspecialties. So within histopathology A bit like how you can sub specialize in other, uh, in other specialties. Uh, you've got cervical cytology. So that's something kind of halfway through your training. You can decide if you want to specialize it. So those are your, uh, cervical smears? Uh, the country's actually regionalize that now, so that's why they're not done everywhere. And actually, training is a little bit difficult, but it is quite interesting. Pediatric pathology. Uh, there is a really, really sought after. So if that was something anyone was interested in, I've been told in a literal talk. They will just create the job for you. Um, there's neuropathology as well, which is again It's quite niche and forensic pathology, as I mentioned. So that's more to do with, you know, quite long court cases. And I would just say it's not for the fainthearted, but It's just to mention that is different to the post mortems that would be involved in Histopathology and the NHS. So pros. So I have tried to check this list with other consultants and registrars, So it's not just my personal opinion, but I would say by far the thing that is at the top is work life balance. So, for example, myself as a trainee, I work 9 to 5, don't have on calls and, you know, I get the weekends off. So, uh, and I just can imagine anyone is foundation doctor like I can just relate to what the rotor is like. And also, as a consultant, you have quite a good work life balance as well. Um, and they don't work weekends either doing wrong in some bigger hospitals. I imagine if they do the difference in sections, things might happen. But there's no night shifts, nothing like that. So something to consider, uh, you also interact with variety of different healthcare settings. So, for example, you'll also get things from GP. So GP might have seen a skin thing and they just take a little shave and then they send it in. Uh, you get it from the hospital as well. So it's quite nice and that you kind of have your foot in every single door. As I mentioned, you get lots of variety you can. You can diagnose so many things in the morning. So for me it's just like almost overload with interest. But it is just great. You'll never be bored. You're always learning which for me is one of the great things. I I preferred about the specialty because, for example, when I was in medicine, that it's great. But a lot of time is half, you know, service provision. You're going through the motions where I see consultants see things like new almost, you know, every other month or so, and that's when they're, like, qualified. Uh, because, as I mentioned, you can make rare diagnoses. So that's something that's, you know, really important. Because, for example, I had a patient patient case on my very first week, which is an appendix. Uh, you know, it's all those anytime appendix taken out. It's sent to us, and I found a neuroendocrine tumor, which, you know, obviously the patient had no clue about, but by us having a look at it And you being able to say, Yeah, this is what it is. It means a patient now knows about it and actually they can take it all out, which is great. Uh, and I think my main point for pro is that I You know, a lot of people say you want to become a doctor, you want to help people, so you, as a history pathologist, will aid the care of so many patient's. You know, every single case you look at is a patient. So even though I know there's no patient contact, each slide is technically your patient or any specimens and things like that. So don't get me wrong if you know patient's will have no clue about your role within their journey. So I kind of say to people, If you want to, if you want to be the hero and that kind of thing, probably gonna be a surgeon, you know they're amazing Patient's remember, You know, one is really gonna remember the histopathologist. I won't lie, but at the same time, I remember, consultant said. But I know and that's all that matters. So to me, I think it's great. Okay, so con. So as I just mentioned, there is zero patient contact we used to do, uh, kind of rapid access clinics. So when patient's had kind of lumps, you know, as I mentioned the fluid to get simple cytology, sometimes the pathologist would have been part of these clinics in America. I think they even help aspirate the lump and things like that. As far as I'm aware now, it's kind of declining, and it's more done in the radiology department. And at most we might go up to just to see the sample quickly to the market or government safe. It's adequate or not, so there isn't patient contact, and that is important for some people. I think it's probably one of the biggest reasons. If someone was to drop out of Histopathology, I think that would be why. So it's something to have a mon card think about, and then the other ones, I think, are fairly obvious. So, for example, high workload, however responsibility I'm I'm sure that's everywhere across all specialties, but pretty so when I go into consultants office and it's just like slides like mountains everywhere. Yeah, it's pretty hard to ignore, and each slide is is very important and you want a quick turnaround. So even though patient's were not to be in front of you, you need to be able to kind of work under pressure and things like that because it will be steady in the background. When you think about the fact that every two week wait sample goes to a histopathologist and any kind of fluid or tissue from any healthcare setting, you can start to see why it just builds up and then, lastly, postmortem. So that is something I mentioned. You can drop it after ST, too, but it's not something everybody enjoys. Uh, so just a bit about the training pathway, Um, so to brief overview so you can enter a straight after foundation train, you need to finish F one F two. Uh, you do about 2.5 years, which you need to sit your first exam. Then you can go onto subspecialized if you wanted to. So when I mention about pediatric pathology, forensic pathology, that's how you would get into those specialties if you wanted. But overall, after about 5.5 years and two exams, uh, you'd be qualified and you'd be ready to go so short bit about the application, which I believe the advert has appeared today, and I think it's opening tomorrow, so it'll be on oil. It's a run through program, which I mean, I just thought it was great for essential. We all love applications. Uh, long listing is gentle person specifications. Short listing is going to be self assessment score ing and whitespace questions so full of self assessment categories. So I did my taste a week in, I think, literally like September of my Year of applications, and I applied exactly the same year and got in the same year. And my application was barely tailored to Histopathology at all because I I decided quite late. But if this is you, like you know, don't don't worry. Most categories, apart from the bottom two are not histopathology specific. So anything you've done don't don't ever think it's a waste. So, for example, also, if you're for example, med students and you're, you know, going forward into foundation years, if anyone ever get like, you know, get you involved in projects, don't get me wrong. It's great if it's part of specialty, but don't worry if it's not a lot of the times other applications as well, because I was basically applied for anesthetics and was going to do that before this. So all my stuff was to do with anesthetics, but it all still counted and anything to do with Histopathology. If I did for anesthetics, I'm sure would work as well. So basically, all hope is not lost and just be as proactive as you can. So white space questions, Uh, so when I've had a look, I think there's three categories on the oral application. When I looked yesterday, um, it's not really clear how they kind of mark this section. I had it last year, and I still wasn't given any clue about what it did, how it was used. What I would say is correlated you're scoring criteria because both together will make your score, so make sure they're they're consistent and then use it as interview preparation because, you know, everyone is quite busy. Uh, you know, if you're a foundation is especially where with rotors, it just helps. You kind of be more efficient because they're they're quite good questions as well. But don't fret, too much about it. Uh, and then the interview. So this is what I looked at. The guidance, I think yesterday. So it's still gonna be virtual in 30 minutes because I think pre pandemic used to be in London. So the first station is interpreting an image, which is something I'll show you an example on the next slide. It sounds really odd, but I can see where they're coming from. You basically are. Describe the painting, and what this is trying to mimic is if you had the phone, another pathologist for advice, Don't be wrong. Digital pathology is about to blow the station at the wall, But at the moment, if you have a microscope, no one's gonna be able to see what you're looking at. So you need to be able to describe what you're seeing over the phone. So that's what it's trying to test. So when you look at a painting, it's like you need to give a broad overview, and then you either start left right up down that kind of thing and just give as much detail as you can. They're just trying to check when you look at something, are you taking in all the detail. They just want you to verbalize it. So it's going to be lots of things you're taking subconsciously. But just if you are going to prep for the interview, just get literally people to just Google paintings, Uh, or you google them yourself or something like that and just you give it to them like they give it to you and then try describe it to them when they can't see it and show them after. And then they can point out what was missing. Something like that. Uh, and then the other questions, Uh, so his pathology is a career team working. It's all quite generic clinical know, knowledge scenarios that might be kind of talking through a patient. So I think I had a patient presents with chest pain and breathlessness. They literally want you to treat it as if you're blocking them. But go overboard. As in, I would take a hit like just say I would take history. I would ask about this. This and this, try to keep it concise examination. I'll do my inspection, uh, etcetera. All these kind of things, uh, going to differentials, investigations, treatment, etcetera because they need to know. You still know the clinical knowledge because that's what you need for then looking at the slide because the most dangerous thing Histopathologist can do is diagnose it blindly, because the clinical is what gives you half of what you're going to start looking for. Clinical error and audit again. Just generic questions, Uh, and then a case study that might be explaining the pathophysiology. So something like heart failure. I think it's come up the last five years. I honestly thought they would change it for mine. They didn't, um and but it's not. It's not something that's really complicated. It's kind of, you know, final year med school stage. Just be able to talk through. Uh, my main advice is to work on timings and be concise, and I think that's true for all, especially interviews or even if you're not applying for this one. So when I applied for Anaesthetics before, I actually did the interview twice the second time, I think the only reason I scored highly was because you just need to make your examples, uh, really, really short, Uh, and I'll just give you an example of the painting. So this is the painting I actually had in my interview, which, annoyingly, I did Google and then didn't describe it, which is great, but it all worked out. Okay, so long. Story short, when If you are practicing and this is something you'd want to look into, you just look at the painting. You'd say this is a painting of a rainy day, looks like within a city to people outside with umbrellas and then start from the left and just described as much as you can. So I remember I started with the artist signature, which, to be honest, I couldn't read because it was on teams and this big, Uh, and then just say there's a building there. It's got three stories. Uh, there's a set of doors on the left. Most side above it is some window is a window that split into six sections, equal size of squares. It's that type of detail, basically, but it's just to give you a bit of flavor of what that is, because it just seems really odd when someone says interpreting an image. But that's literally all it is. It's It's not really anything to do with your medical knowledge just try to describe the painting, and I believe that's it. So if anyone's got any questions, be happy to answer them now. Thank you so much time via, um So if you guys have any questions, please do put them into chat, and we can see them and answer them. Live. Well, we've got a question already, actually. So can you elaborate on the clinical error and audit situation? So, for example, one of the questions I I had, uh, was it can be as simple as, like, describe to me how you would do an audit, and they literally want you to be as, like, be as detailed as possible. So I would come up with the question for the audit. What is it I want to assess? I would then pick my standard. I would then collect the data compared against the standard analyze it recommendations present. Reorder it. They literally just want you to describe that cycle. Uh, error might be something to do with, uh, you know what? If you you made a mistake, how would you handle it? It's just checking like probity. You need to take responsibility. So, for example, as a history pathologist if you, uh if you signed out a case wrong, you might have got slides mixed up. You know, it's it's really important that mountains of them. You sign that out and it's gone to the commission what you're gonna do from there, just showing that you're being safe. You know, patient safety is still a priority, even though they're not in front of you. So what? Get hold of the commission straightaway. What's happened to the patient's own up to your mistake? Take some learning from it. Things like that have an answer, this question. So whilst we wait for any other questions to be popped into the chat, I have a question for myself. So when when was it that you actually decided that Histopathology was the one for you? And what sort of things did you start adding to your portfolio to make your application competitive? How do you actually find the time to do these things? So it's been embarrassing, you know, I kind of got into it. Long story short, I got into it by insulting it at the start, which is where I'll eat the words for the rest of my life. But I basically said I would rather die than spend all day looking down a microscope, so, you know, clearly take all of that back. Um but I didn't know what I wanted to do. I'd work through ophthalmology, anaesthetics, palliative care? Probably. I think Portfolio gp. I just didn't know what I wanted to do, So I just thought, you know, that was my med school opinion. Throw that in the bin and go and see what it's like. So to start with, So last year was a teaching fellow. Uh, I just took some time out to do a taste a week. So taste a week should get you, I think at least 3 to 4 points on one of the questions. Um, so that helps you decide if it's for you, then in terms of building your portfolio. So the self assessment criteria should be out now. Uh, as I said, anything you've got before should still count. So, for example, I've done whole teaching program before that already, but it was for I t U. But it's still counted, so make sure you get together everything you've got. See what counts, then just go about just filling things in. So, for example, you got points for going to Histopathology related activities. So I signed up for all the Royal College. Well, as much as I could with work, the royal college events. So there's an international pathology conference that you could just register for. It was virtual again. You get some points there. Um, if you can do an audit in Histopathology, you know you can you can try and do some quite quickly. Um, quality improvement. Remember, I didn't have one, but don't over think that it can be really simple. When I was a teaching fellow, I just noticed we were all going to this For some reason, we're all going to the same wards every morning to find patient's. So I literally got a white board, said, Everybody write down in the morning where you're going and I just collated how many times you clashed before the whiteboard. How many after? Oh, look, Improvement submitted this project. It counts. So don't don't overthink like it has to be a massive project. Just be guided by the criteria. That's amazing. Thank you so much. I was so helpful. Um, so we've got another question from Rui. Uh So how is the clinical knowledge scenario different to the case study? So I think they've worded it differently again. So why I had last year might not be exactly the same. I will have to say that because obviously I don't know. The clinical knowledge was when I mentioned So patient comes in with breathlessness or my my interest even say breathlessness. Patient comes in with chest pain, something like that, And it's about you just literally going through. This is what I do for my history. This might do my exam differentials, investigation, treatment, all of that. But they might do something like someone comes in with who's a heavy smoker with hematemesis. What they're trying to do is make sure you don't go straight to I think it's noncancer. Don't get me wrong, you're right. But the whole point is you just got to demonstrate that thinking a case study might be more that actually, they want you to talk through the pathophysiology of heart failure, for example, they say, you know, patient's come in, they might show you, maybe don't know photos of swollen feet and, like pulmonary edema. And then they might say talk through either. Maybe the finding. So what? What is this? Just describe it. Don't say exactly what the cause is, because again you don't know. But then, if they say, describe the pathological process involved in heart failure leading up to us, that's how it's kind of a case study. You're kind of looking at select things almost like you did an article, but clinical knowledge is working through as if you were clerking a patient, if that makes sense. Thank you, Tom. Via So, um, the next question is from eating new to, and she's asking, Why did you pick Histopathology and how are you finding it? So as I mentioned, I insulted at the start, which I take back now because I'm now actually in especially. But I picked it because when I did my taste a week, I realized, like all the things I've tried to summarize in the presentation like nobody knows about, I feel at least from when I've even spoken to my friends now who are in training. Nobody really knows what Histopathology is, And I just really liked the concept of like I I really enjoyed diagnosing, but I'll be honest. I'm not that bothered about the rest of it. So like when I was clerking, you know, patient comes in and, you know, you know, I think I think they've got pneumonia. Do the chest X Ray Epps pneumonia treatment. Then I got to wait five days and then they go. But I actually just like being able to use my clinical knowledge because I still use it every day. Get to still, look at radiology, get to look at a new thing, which is the slides. Then give the diagnosis, help the patient, but then just kind of move on like that's that suits me. It's It's purely the fact that it's It's like diagnostics. And I just get to keep going with loads and loads of different puzzles and the sheer variety just It just keeps me interested. But I know that that isn't for everyone, for example, So like that would be the polar opposite to two g p. For example, uh, in terms of how I'm finding it, um, so I'm in ST one, So I started in August, so it's only been about, say, a couple of months. I will say the learning curve is is like that. It's just not even, like a little bit. It's just straight up vertical. But at the same time, it's really interesting. And I think since med school I haven't had the opportunity to just just purely learn. So, like, I'm super new Meriel I'm only there to to learn. And I think it's quite a privilege we have in that are Training is is literally to just just get you there. You don't have to do service provision. I think when you start to learn more cut up, you become part of the lab team. Um, but I'm quite enjoying it. Uh, and as I said, with the content, it's not. It's no patient contact, but it's not no people. So you get to, like, see all the roles behind uh in the lab as well. And, you know, they're always a great bunch of people, so it's good. But Steve Bannon cuff Uh, and then as a training, can you opt in to pull more PMS? This is your area of interest. Continue about certificate. Well, if you are interested, uh, in autopsies, people will like just you'll be so, so employable because there's like a national crisis at the moment with histopathologist not doing autopsies. So if if you wanted to do more PMS like there would be plenty, they would make sure they can get you there. You can actually do the certificate of higher autopsy training as a trainee so that you might not have even CCTV as a consultant. And you can start doing them alone, providing you have that certificate. So terms of details about the actual certificate itself. I know that you have to kind of complete your training. Think you have to do up to at least 100 autopsies to, then get your certificate and then you can go off and do it on your own. Um, but I think that's the level of knowledge I know at the moment, because I think you've got to do your 40 and s t two and then decide. So if you if you want to do it, um, that's the time to let people know. And and some histopathologist purely do autopsies because it's their area of interest. They don't even do any of the other stuff. So if you want to do it, you will be in such high demand you will get a job anywhere. I promise you, I have not done an audit yet. But who can do one before the entry stages? Will that work against me? So I don't know what I mean about work against you. What I would say is you have to when you're doing this self assessment criteria, you'll have to be honest with what you have now because you have to upload it. Uh, it's not the end of the world. I didn't do an audit before I applied, and I was like, Oh, my God, I really want to do it But it's just kind of time. Um, but if you've done audits, another specialty, that's great. Upload them, you know, see if they count as well. But it's just not the end of the world if you haven't done one, but you'll have to. You have to take what you have at that precise moment in order to upload it on the evidence portal. Because once the portal closes, unless it's changed, um, we weren't allowed to amend anything, even though they marked it, like months later, which I did find annoying. I couldn't I couldn't I could change it. So if you haven't done it, don't for it. You can get points in other places. And I said I registered for Royal College, you know, virtual days and I've got at least four points from Just keep doing that. So it's not the end of world, um, any textbooks that you would recommend for beginners. Um, so I'm pretty much a beginner as well. Um, but I could give you a mountain of textbooks, but I think just to start depending on where you are is honestly just what's normal? Because if you don't know what's normal, it all just looks like an absolute mess. Like I have days where I'll be like, Okay, I think it's this and I'll go to all my different resources and I'll have other days where I don't even know what to Google. I'm just so lost. Uh, so I would go with probably Wheater's histology. I bought my addition for three quid off eBay. Don't spend loads of money on the latest one. Um, because the photos are exactly the same. My consultant gave me her second edition from like the 19 eighties. I opened both. They had exactly the same photos. Um, so I'd go for just a normal histology book. Uh uh, Wheater's. And then if you want to look a bit more into pathology, go for Witters pathology atlas again. It's quite small, and you can get it quite cheap. And that will start to give you an idea of what abnormal things look like without absolutely throwing you into the deep end. Super. Thank you so much. Ambien. Um, there are There doesn't seem to be any more questions coming in at the moment, but we can I don't know if you're busy time, but I'm happy to stick around for another couple of minutes to see if anyone else Any other questions? Yeah, it's a gram for another minute. Spin Islanders. I'm happy to be contacted. If anyone has any specific questions you might think of later. Super. Thanks so much. We're getting some Thank you's in the chat as well. So thank you so much for your time and thank you everyone for attending. Please. Do you make sure to fill in the feedback form before leaving? As soon as you get a chance. Um, and if you have any comments to send to Tanveer We can, um, send them her way, as long as you guys can put something into the feedback form. And super. Thanks, guys. You are giving me hope. All is not lost. I promise. I literally decided two months before I applied to say it's all right. Well, good luck for anyone for any specialties you choose. You know, I'm obviously biased and think this is the best, but good luck. You'll you'll be fine. Okay. I think that's the end of the questions, too, because I'm gonna still broadcasting and thank you so