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Welcome everyone to our event today. You can see some people are still trickling in. So we'll give you a few minutes just to settle down and for a few more people to join us and we'll be soon starting with our first speaker. Okay. So I think we'll get going now. Um Welcome everyone to our event today on academic plastic surgery. We at Black Pressor Bart's in London Plastic Surgery Society are really happy and we're really excited to have collaborated with Imperial Plastic Surgery Society and Bart Academic Research Society for this event. We put together a really exciting lineup of speakers today who will be able to give you a bit of better understanding about academia and performing research in plastic surgery. Um All the talks today will be recorded and then they'll be available on demand on the medal platform for a short while. Um And if you have any questions, just put them in the chat and we can go through them at the end of each talk. Okay. So without further a do I'll introduce our first speaker. Um Mr Juan Burner is a, is a plastic surgery consultant faced at the Royal London with an interest in micro surgical reconstruction and academia. He has published extensively extensively during and after his training and he completed an MSC in Surgical sciences and practice at the University of Oxford and is currently a phd student at the same institution. So Mr Burner, if you're ready, um please take us away. Thanks, Louis. Thank you very much for having me. Um Can you hear me well? Yes, loud and clear. Yeah, I'm just going to share my screen. So, um Louis asked me to uh present a little bit, how is the training pathway to become an academic plastic surgeon? Um But I said to him when he first asked me that if we looked at this NH are integrated program to, to become um an academic in, in any specialty. Um Well, I haven't done any of these. So I told him that I was not best suited for um for that task. And I think you have Justin, who's gonna talk to you a bit later today who has done a part of this pathway and he's an excellent speaker. I'm sure you will enjoy. So, going back to my first slide, uh despite not being able in this in this pathway, I have been able to publish while training in plastic surgery. So I was hoping that I could take the opportunity to talk to you about the different strategies I have found useful and the different and, and the approach I've had doing my training to try to get the most of my clinical experience, but also using that opportunity in clinical practice to get ideas and get them published and build up my CV uh and also developed uh an interesting academia in general. So going back again, this, this is the pathway which is has been designed by very senior stakeholders on how a doctor coming out from medical school can follow a clear direction. Uh if they want to become lecturers or professors in the future. And obviously, it's a long pathway. Uh and this is the kind of the common pathway that you will find in any hr websites. Obviously, for plastic surgery is a bit different because our training takes a bit longer. Uh We need quite a lot of clinical experience while we're training. So this means that even though this diagram goes up to ST six plastic is up to ST eight. And obviously, if you are doing research 25% academic or if it was an academic, then this can take 10 years plus to complete in terms of plastic surgery. And I know that if I got 25 of you logging in on a Saturday morning to hear about what's going on with academia. Obviously, this is this is wonderful news for all of us who are interested in research, but it can be quite another taking to think. Oh, okay. I have to go through my finals. I have to find my foundation, hopefully academic foundation, then I have to find my national training number, hopefully run through plastics and then, you know, secure this competitive interviews and and get this clinical fellowships, cleaning lecture ships. Um phd take time off and you can start really, you can get really, really just overwhelmed just by thinking about it. And, and obviously at the end of the, at the end of the journey, we want to get to this goal to become an academic or professor. Uh And that hasn't been the case for me. I never wanted to become a professor, but I've always seen myself as a clinical, a plastic surgeon with interest in complex reconstruction, but with also an academic interest on the side, which I've tried to keep alive while I've been training. And obviously, when we're talking about journeys, you know, I come from Chile, which is a country a bit far away. We speak Spanish over there. And the probably the Shakespeare equivalent in the Spanish language is uh Cervantes. And he wrote Okay Cotulla Mancha, which you may have heard of, which is this the history about this old guy at the end of the medieval times into the renaissance who was really really uh missing or was really inspired by the knights of the medieval times. And he was seeing how uh these nights were disappearing in his age. And even though he was growing older, he thought that he, he really wanted to go out for an adventure and obviously he gets lost. He has a good friend by his side, Sancho Panza. He even got into a fight with windmills example and thinking they were giants. But there's there's a bit of wisdom in his in his um story, which is I think very powerful that is not about getting to the end of the journey necessarily what has to make you happy. But actually enjoying the journey is as important as getting there. Uh Because thinking, oh, I'll be happy when I achieve my goal in 10 plus years time uh without enjoying the journey, I think it's something very silly and it's far, it's, it's easy to get burned out. And this is not something, you know, just unique to this also, but it's something which is present in many, many cultures. So just looking at my, my, my own journey, I obviously, every time I go back home, I have to look at this map and I said, oh my God, I have to fly 14 hours now to get to see my family. I come from far away and uh landscape where I, where I'm from, which is Santiago, the picture in your left. You can see that there's a very dramatic landscape because it's by the Andes. And I really miss, you know, seeing mountains when you go to bed and when you, when you're asleep, when you're driving to work. And obviously, now I live in a beautiful country which is the UK. But, you know, we have heels, we don't have mountains. So that's why it always makes me, you know, feel a bit homesick when I look at these pictures. But sometimes trying to become a plastic surgeon or trying to become a surgeon of any specialty can seem to be similar to climbing a big mountain like MT Everest in this picture. And then we're saying, okay, it's going to take quite a bit of time and effort, you know, and building up my CV to become a plastic surgeon. Well, it may be a bit more difficult that maybe I'm interested in becoming an academic plastic surgeon, which can be a bit, you know, even more competitive, even more uh of an effort. But then, you know, people that climb Mount Everest, it's not just that you can trail all the way up in one day, there's several camps, there's different roots and there's a journey you have to do and something you have to go forward to them, go backwards and then go forwards again until you end up reaching the summit. Um uh hopefully at some point, but it's not just about, you know, the way and taking one, taking it one step at a time, but also when you're climbing something like Mount Everest, there are different routes, there's no just one pathway. And if you keep your mind open, you can, you will probably notice that there are different ways of getting where you want to be and not, not just to one, not just necessarily the one polishing in hr website, which is a wonderful one uh by the way, but it may not be the right one for, for everyone. So having said that, I think it's quite important to question ourselves and, and, and because this will take time effort, you know, and it's difficult to uh you know, after a busy day at work, go back home and, and write papers or do research or gather data, it takes time, it takes time away from your hobbies, from your family, from your friends. So I think it's important to see, think about why, why, why don't, I don't want to do it. And then is it because it's like, you know, the holy grail in the Indiana Jones pictures and actually doing research will give us eternal life in a way of not, not eternal life ourselves but transcendence, you know, living something for the future generations, you know, in a very wide sense or living something that, you know, our names will, will stay there in those, in those journals as they, you know, as the dust is collect on top of them. Uh I don't think it's going to be the case. I think it's very difficult to pretend that, you know, research career will, will give you that sort of transcendence because what we published today in 10 years 10 years time is going to be out of date and 30 years of times probably gonna be forgotten unless you have a really, really big breakthrough which some people do. Um But not a lot, not all of us or is it research all about, you know, being, or becoming an academic plastic surgeon? Is it, you know, because we want to be part of, uh, you know, elite group of people um to the, it's not just about the plastic surgeons, which is a little club on its own, but academia, you know, with people talking about, what's your age index, how many citations do you have have used? I have or, you know, uh these kind of conversations average so many citations. I'm so happy or the general published my researches have a so high impact factor and then I my score researcher gait is going up well, some people may, may see it this way. I don't. Uh I think uh the reason why I like doing research is because I really, really enjoy dealing with patient's and I really, really enjoy helping them uh in their journey through, you know, sometimes having complex reconstructions, uh complex cancer treatment or, or doing the sequela of, of trauma. And there's nothing that is, I, I agree with one of our, you know, founding fathers of, of plastic surgery in the UK actual mcindoe that the real satisfaction can be achieved when you see that the patient's are going back to basically doing what they were doing before um they sustain their injuries. Uh So research is a way of also treating your patients but not just just your own patient's, but also helping patient that maybe in different units, uh either by share ing what the, the good things you do in your unit by or by the introduction of new technologies or, or also by discovering and pushing the boundaries of knowledge to in a way that will actually benefit patient's in the future. And, you know, from a broad sense in terms of medicine, you know, we've gone through a long journey on the left, we have Imhotep, which was, you know, one of these a change. Well, he, he was at some point considered a God in, in uh in ancient Egypt, but he originally was an architect, but also was a physician. And he looked at after pharaohs and at that time, the difference between a medic uh scholar and the priest where a bit blurry. Um so wisdom was acquired by observation experience, but also by faith um which then changed in ancient Greek. And in ancient Greek, we found people like Hippocrates, which um uh he, he was able not just to uh question, you know, knowledge acquired by faith in terms of medical practice, but also really kind of uh put the uh said in a very clear way that observation and critical observation of signs, symptoms and also the progression, disease were much more important. So then that your treatment could also also be more predictable with the limitations that they encounter at the time. And then we go a few centuries later to James Lind. And you know, he's for the first recorded clinical trial or proper clinical trial when he was treating the patient with scurvy. Uh I think the 17th century. Um So, so we've gone a long way in this, in developing rational thinking and the way we do research. And even though I'm not gonna, I talk about research methods because that can be read in a book. Uh I wanted to just share with you a few thoughts. Plastic surgery has gone through the same journey, observation, you know, recording success, recording failure, learning, learning from our mistakes. And there's some techniques we use that have been, have been in use in our Armamentarium as a specialty for centuries. So the forehead flap originally described in India brought to the European continent uh 3, 303 150 years ago. Uh Bye bye, members of the East India company. But it was after that was, you know, being used without any sort of analgesia or anesthesia at all in the in Asia or the works of to glucose. C as you can see. Well, is the, is a patient that has a bit of his arms stuck to his nose to reconstructed uh which was developed in the renaissance period or then later on, you know, second World War article mcindoe in the picture of the right, he was, you know, developing the use of skin graft to reconstruct extensive burned faces. And one of his nurses was a very talented um about then, the artist was able to document this uh in these amazing drawings that have been published in J Pre's. But then in the 20th century, I think we, we, we become, we, we went from that rationality and that observed political observation period to really becoming a bit more scientists. Uh in the way we we we see researching plastic surgery. And I think there are not many passages that have won a Nobel Prize. This is one Joseph Murray who was the first surgeon to do a renal transplant, successful renal transplant. So he was able to do this transfer this kidney uh in Boston, Massachusetts in the sixties. I'm so sorry. I think it was late fifties, early sixties. Um and he wanted old rose and he was the plastic surgeon. What was the plastic surgeon doing transplanted kidneys? Well, for a long time, our specialty has been associated with transplantation even though now it's the biggest thing among neurologists and general surgeons doing transplant, liver transplant, organ transplant characteristics. Uh platitudes were the first ones to, to do transplantation in a very simple way by doing skin graft, seeing what failed, what worked. Uh Nowadays, I think there is uh this uh this uh renewed you know, area of plastic surgery, taking over, taking back what was originally hours with the development of facial transplant hand transplant. In general terms, vascular composite after transplantation and all the science that this involved, because this is obviously not just an anatomical issue or a technical issue. It also has a lot of uh immunology involved um in which practices are getting involved doing the research or some people may feel a bit, you know, excited about the fact that nowadays we're really pushing the boundaries with uh tissue engineering. And maybe in the future, what I do today, which is transplanting tissue from one part of the body to another two full a problem won't be necessary because we may be able to get tissue, which is we won't be rejected of the shelf. Um Obviously making things much easier for patient's. Uh but there are other areas, areas of plastic surgeon which are quite exciting. Um This is a picture of someone's abdomen. Uh You can see there's a t kind of scar is because this, this, this tissue in the abdomen has been, this is the umbilicus, it's been splitting to have and then there's a scar going from hip to hip because this is patient's going to have some tissue have. Is it from the tummy to reconstruct the breast? But by injecting and assign and green and using uh flourescent lamps, they are able, we're able to identify how much perfusion is get in the tissues in real time, which can be, you know, very useful in our clinical practice nowadays because then I avoid transplanting tissues of poorer quality or is that don't have enough perfusion to survive once they are moved over uh in the form of free flap. So we've talked about what's going on, but again, focusing about ourselves and what's going to be our journey. Um We, we, we go back to these same questions we started with and I believe that in similar way, uh clinical practice, clinical progression or learning any new skill, I think that doing research and writing papers is not that different in terms of the fact that there's a learning curve. So probably in writing my face paper, it took me ages, it was a real pain. But suddenly when you're writing more and more and you're getting used to it, then you see that you're going through this learning curve and you are kind of learning how to do it as a skill um on its own. But there are ways of going to this learning curve like the black line, you know, like okay, it's kind of steep and long and boring or you can try to go a bit quicker through this learning curve and try to get to the point that you are enjoying a bit more what you're doing because you already know how to do it and you're getting the results you want. And I think that like in clinical practice, there is a way to, you know, move from the black line to the green line, which is by, you know, mentorship, having friends uh and getting proper training because training can get you, you know, up there, whether if you just try to do it on your own, you only get experience and experience is important. But I think the the whole point of training, even if it's clinical or academic training is that someone is teaching you or showing you things, explaining things. So they're easy for you to understand. Uh but not only that from a very paternalistic point of view, but also you are able to learn from other people's mistakes. So then you don't have to make the same mistakes again. And, and obviously, I mean, what uh do these people in the picture have in common? We got the Beatles, we got a professional football player who's Chilean, by the way, Alexis and my colleague, Geopathic Pain is performing a complex uh reconstruction on the bottom, right? Well, all of them uh they have done the 10,000 hours, all of them have become experts in the field and I think becoming experts in the field, it's not something easy, it's not something that you usually are born with, you know, uh with the talent, but it's something that you need to work hard. And there's a concept that people use for clinical training and especially microsurgery, which is the concept of deliberate practice. And is that sometimes in order to become, become an expert and really go through this learning curve quickly, you need to practice and practice hard with an intent. Completely focus in order to get to a goal, but in a way that you're not necessarily enjoying it. So I'm telling you, if you're writing a paper and you're not enjoying it, that's normal. It doesn't mean that you don't, you're not going to become a researcher, but that doesn't mean that you won't be able to publish a paper. What I'm telling you is at the beginning, writing papers can be really hard and uh you know, to get better, you need to keep doing it. Um But believe me, it's not something you will enjoy. At least I didn't at the beginning and I wanted to give you a few strategies that I have found useful and I will give you examples of papers I have published so I can talk from my personal experience. So please don't, don't feel that this is, please don't think that this is the only way to get to, you know, the point that you can cause if academic, I don't call myself an academic often. Uh but some people might be able to publish papers by following different strategies. I'm just gonna share my personal views. So the first one is think big but start small if you try as a medical student to get you know, massive amount of funding to run the next biggest plastics, you know, randomized control trial. It's gonna be very difficult. I'm not saying it's impossible. Maybe your, you know, amazing what you do in your social support that you will be able to do it. But for most of us getting into academia and start reading papers, start with smaller projects. Uh so you can build up your experience and C V to then undertake bigger projects. So case reports at the moment are not well regarded in the literature. They're not published by every single journal. Uh They are seen as something that probably is not adding too much unless they are super rare. Uh But case reports are easy way to build up your writing skills. So if you see a patient with a very complex humor that is a complex reconstruction and maybe things didn't went according to plan and you had to think of a plan B or your boss had to figure out a way to, to solve the problem. And your boss tells you this may be interesting for our case report. Don't disregard it. Oh, it's just a case report. It won't, it won't work for me this, you know, we'll give you the opportunity to then transform it into a nice paper that you can publish, you know, and it goes, goes to your C V, you're able to learn, you learn from the reviewer's comments and, and I think it's a very valid way to start or if you want to become a professor, I miss masterly straightaway that just by writing case reports you won't get there. But as a starting point in maybe, maybe a good and valid point. Another, another way of writing short articles that don't demand a lot of effort and can be easier to approach is by publishing and sharing points of technique. So I was working in Westminster with breathing surgeon called Mark Pickford who had, when he was dealing with difficult fractures. And he needed to distract a finger in order to get all the bones to come closer together for the fixation to take place. He would sometimes put a K wire away from the fracture through uh uninjured bone. But you would use this uh to help with the destruction. As you can see, with your left hand, you're able to distract the fracture from a far away distance, letting the primary surgeon to complete the operation, whether you're just pulling someone's, you know, the little finger with you with, with your bare hands. When someone is trying to do a very complex, you know, fracture fixation can be very tricky. And I found that this point of thing, it was really um interesting and clever. So again, I went on and published as a letter. Um And again, it's just, you know, 500 words, it's not a big undertaking. Uh And even though if it takes you longer at the beginning, I think it's a very good way to start. And at this point, you can sometimes, you know, influence how other people practice. I think it's a bit more interesting than a case report. But you're actually sharing a skill, sharing a technique and then people can learn from your practice or the practice that is, you know, how the way that protected approach in your unit, the, the second uh piece of advice or second strategy would be to try to pick winners. Sometimes you will go get you need. And if you're the person, you know, entertain in academia, you will see that people will start approaching two. You're saying, oh, would you like to, you know, do this project with this project with this project? Um And um the beginning, it was very difficult for me to say no. Um but I think that there are some products that have more future than others and it's very difficult to tell you exactly what a good project. Um how to identify a good project operator will end up in the publication. Uh But I'll give you some, some clues of what I think, you know, it has worked for me. So a very, very, very obvious one and I cannot, you know, uh ignore is that for example, when the COVID pandemic happened, all the journals were published about COVID. And even you would have, you could have a serious idea, but it was something slightly interesting uh well written, then you would definitely get it in and I was also part of that trend. Uh So, uh I was doing a project that will tell you a bit more about in a minute uh to see how, you know, the quality, not the quality, but how no limit construction is done in different countries for patient with open fractures. Uh So my project was gonna take a year, a year and a half, but I was able to capture just three months using the same team I was using and we were able to polish a quick paper on, on this matter and how COVID has affected the management of these cases. But also even something more simple than that. We also that there were hundreds, got thousands of webinars being advertised weekly and there was a slight pressure, you know, you, some of us had a bit more extra time, some of them, some of us were working really hard, but when we had extra time, we could be at home for a day or two uh doing pretty much nothing. So you felt like a bit pressure to um attend all these webinars and learning opportunities that were being advertised and they were just too many. Um So we published a paper about the trends and and the access to webinars between the pandemic and this letter got published in acidic surgery General, which is quite a big journal for plastic surgery. Um another way of picking winners is trying to see things which are innovative and that if you read the literature, you will see that if there's not much published about the subject. Um sometimes even publishing the first paper on something or, or the first, you know, it can, it can be easier to get into a journal. So for example, this is a technology called inverse which is a special piece of quit that honest, it's used to monitor black profusion in brain. So it's like a sensor is able to to sense uh profusion and oxygen uh presence, you know uh through a certain depth. So it can basically this this sensor is not sensing the profusion of the skin or the skull, but the brain. So we thought, oh what do we use it for monitoring free flaps or even not that pedicle flaps? And we published a paper about that and it got accepted uh in the European journal of plastic surgery. Similarly, uh nowadays, you know, lymphedema surgery is becoming a big thing for plastics trying to reconstruct someone's soul and limb after treatment after the uh you know, suffering from cancer or trauma is something that seems to be very rewarding. The evidence is is improving. Um but also neutralizes have been introduced. For example, these surgeons on the right are not looking through a microscope. They are actually looking well at the images projected which are captured by a microscope and they're using special glasses to get the three D uh to get a three D sense of what's going on. And this is a hospital in Germany when a friend of mine is working and they were using this technology. I said, okay, we have, we have to publish you experience, even if you have done just a handful of cases and this got published as well. So sometimes, you know, looking at things which are innovative or things that are having recently introducing new unit um or something or, or projects are, you know, trendy because, you know, uh for example, climate change, I think the sort of we we should do about climate change in plastic surgery and no one has really kind of developed a research in or at least that I'm aware of, no one has kind of um developed a strong interest in that I published also, I didn't put it here, but I published a paper a few years ago on how to measure the carbon footprint of plastic surgery operation. But obviously the message interest where somewhere else. But if someone would like to talk about climate change in plastics or how we, how we reduce our carbon footprint, I know that it would be probably a winner. Another strategy is try to avoid collecting what some people call digital dust. So it is an old hard drive and sometimes, you know, we do things because we have to complete an assignment or uh you know, we wrote a paper but we left it hanging there, we never finished it. Or sometimes you get to uh to work in a unit and they tell you someone has done some work about this particular technique or this particular approach, they have collect all this data, but then no one ever wrote it. So basically, the database is ready to go collecting digital dust and that's a brilliant opportunity uh to then get it out and get it published and get it finalized because then you don't have to start from scratch. So on the left, there's a paper that I published in microsurgery about the use of the skip flap, which is one of my favorite uh micro surgical flaps. This had been uh technique that was developed in Japan by one of the bigger biggest names in my coffee, which is called, is a Professor Issac Oshima. Um And one of my mentors T CT of in the screen stone had been doing the same technique even before Kashima published it, Kashima did the first case. There's no doubt about that, but T C was pretty close. He had been collecting some data and some people had worked in the unit and had done some data gathering and we knew we had an interesting number of cases. Uh And then one of my friends Darreus, she just so told me, Juan, why don't you get it? And just the table is actually, you know, not half written, but there's some progress written somewhere. I'll send everything to you. So I assembled the whole thing and, and we were able to get it published. So it wouldn't, you know, carry on collecting digital dust. Similarly, when I moved to Newcastle for my fellowship, there was a project going on for years trying to see, you know, how uh what, what, what were the outcomes of reconstructing major versus when you're taking big, big aggressive. So comas from someone's extremities and that was a database also gathering digital dust and you just need a tiny bit of analysis because they were not, it was not a big number of patient's. And then he's been writing up in terms of, you know, when you've already done your project, you've written your paper and then you, it gets to the point that you have to submit it for publication. Uh It's a, it's a point that always makes me be anxious trying to choose what's the best general you want to get it published. That's, that's obviously, that's quite obvious. And you wanted to get it published in the best general possible. I think that's also obvious, but you cannot submit the same paper, two different general at the same time. So you need to pick and choose the best one for your paper and sometimes you can aim a bit higher, maybe, you know, uh get a bit greedy and try something, you know, it's gonna be tricky but you make it out, you may get away with it or you can be very realistic and sometimes, you know, published in the journal, which is not so um uh not as prestigious, but it will get your paper published quicker, accept it quicker and published weaker. Uh It's not irrelevant because sometimes, you know, interviews are coming, grant applications are coming and you just need to demonstrate your output. So I think there are different, you know, strategies approaches. And if you read about this nature, there's so many people, you know, commenting about that. Um what I, what I want to tell you is that the process has its flaws. And sometimes, you know, getting a paper in a good journal is not just about the quality of the paper, but also a bit of luck that the, maybe the editors liked it or the reviews liked it. Um But I always would look at the scope of the journal, think about who's gonna be reading it. Uh If the readership is gonna be interested about your paper and then once you've read, you've, you've understood the scope readership and the interest of the people that usually read the general, then think about Impact Factor. And uh other, other, other matters such as uh turnaround times is because you can have the most amazing paper in orthopedic, you know, trauma, but it isn't it to uh surgical general, which basically is focusing on general surgery research. I mean, you will get rejected or you would struggle. Uh So thinking about this can be it, I think it's safe time. For example, sometimes you may do something, you may be developed a technique or you may have witnessed uh interesting case which for a plastic surgeon, it's bread and butter but made for a different specialty when, especially when we as especially we have to work together, we have to work with other specialties very often, maybe for someone else. Uh It can be quite interesting. So, um for example, in Newcastle ones, we did uh L D flaps while the most Joseph lab very standard, straightforward bread and butter, plastic surgical reconstruction. But we use it to, to cover an implantable device on someone's heart. Uh So like uh it's called L L VAD LVAD device, uh left vertical assist device and we used to cover it and then we, when we did this and the the catastrophic changes were really impressed and they said to us, oh, we have a couple of these places that have had issues with this. We have certainly we never found anything about this. Um How did you come up with us in the world? I mean, this is a page straightforward like for us and we, and, and you know, it's, it's a, it's a usual way for us to reconstruct a problem including this. So then maybe this paper won't get accepted in a plastic surgery general. But it can be quite interesting to uh general focusing on characteristics and actually that paper got published also. I don't know. So, so I won't put it here. Um Some people get obsessed about impact factors and basically will tell you that may be publishing a paper, uh which is will go to a general which is not, has not enough impact factor is a waste of time. I don't feel that way. Um I feel that it's always better to have some something out there. Not just because you're trying to be the career. It's, it's about also share in your thoughts, sharing your ideas and helping others. Uh So some often, you know, uh not often, but sometimes I'll get a paper published, you know, in the European, you know, surgical oncology, which has a really brilliant impact factor of 4.5. But, you know, if one of my S H O s very keen, that's a good project, good audit. And I think it's worth, you know, supporting its publication, I don't feel bad at all in getting in, you know, the European European, you know, plastic surgery with an impact factor of 00.5 because I know that for him, it was an interesting project for him. It may be the start of uh brilliant academic career. Um And I honestly think that uh the results that he encountered when he was doing this audit where was Share NG. And I told you that I come from Chile that I speak Spanish. So if any of you uh have, you know, come to the UK or are living outside of the U K uh and you have uh scientific lecture in your own language. I I won't, it's not a piece of advice, but I really have enjoyed publishing in Spanish because sometimes, I mean, I don't know how it is with other languages, but in, in Spanish speaking countries, we don't train in English, not all of my colleagues speak English. So sometimes trying to get good ideas or a good review in Spanish can really reach a community of doctors that otherwise, you know, the most brilliant English written publication with the highest effect that won't get to them. So I think it's also another way of, you know, share ing you know, our knowledge and our findings and trying to build up and trying to try, trying to influence on the way patients are looked after in other places. And this is, you know, all the countries, especially the ones in dark blue, we will train in, in, in Spanish and not all of our colleagues speak English. And sometimes, you know, in terms of choosing your general, sometimes you may be the the old paper is best suited for a general of not even a medical journal but general of physical therapy. Uh it may be the case. So just keep an open mind and just finishing with my talk, I want to talk about, you know, don't underestimate the power of collaboration. Collaboration is not, I'm not talking about clarity research at this stage, but just working with other people once you've build up your name and you've written a few papers, especially if you're being training the UK you know, people from abroad will look for you because you can help them, you know, improve their papers to make them more better presented, presented for, for submission for publication. So, um I have collaborated with the team in Chile uh with the paper on the left, you know, publishing the ethnic plastic surgery journal, you know, talking about, you know, how we can assess simulation models for aesthetic training. And I have collaborated with my friends from Italy, you know, helping them, right? You know, and develop, you know, uh present are interesting cases of, you know, small ulnar based flaps for digital reconstruction and myself in papers that have done for my phd which have interesting lower limb reconstruction microsurgery. I try to invite people from different places. So I have Italians, Chileans, Germans and British also in these papers. And I would like love to have more people from other countries just, you know, providing their insight and the experience to my work because I think that that's, that's, that's quite rewarding. And I've learned lots of uh from the um money. Um A lot of people tell you, oh, without money is very difficult to conduct research. And I think the right, obviously, money makes your life easier, but in many ways, including academia, but I've not been very good at securing major grants or I find funding applications really difficult. So for my phd, I had very limited resources. Uh And despite the fact that I did some systematic reviews which of course are for free, there's no cost associated with them. Uh I was able to conduct a big international audit on lower extremity reconstruction, which I already kind of touched on uh on, on a previous slide when I was talking about COVID. But the intellect project aimed at uh with the support of the Ice Tea and, and University of Oxford, we were able to audit, you know, the results of lower limb reconstruction in many countries. Um So 17 countries and 2100 to open lower limb fractures. Uh So it is actually, it's like it's up to date. I it was 2, 2700 by the time we finished. Um But we were only able to do that and get this paper accepted, which is, you know, about to come out because we had an amazing group of collaborators all over the world in this, in this map, which were willing to give out the time. And obviously collaborative research has become something really, really, I think better. It was the people that were a bit uh you know, doubtful about its future. But I think it has demonstrated its power. You're not for everyone. Uh But it's an amazing way to do research from an international perspective. Um keeping the costs down and then obviously rewarding the your collaborators or uh in other places um fairly. So the reason why we went for peace general surgery, even though they don't take osteopenic trauma or extremity trauma very often is because they do allow, you know, the indexation of uh the collaborators in parliament, uh which is something we really needed because that's what we had promised to our uh collaborators. So you can see that, you know, starting can be difficult, but really there's no, you know, fixed boundaries. And with at least what uh with the strategy I have presented, I have been able to make possible project that no one. So they were gonna be uh something you know, reasonable to achieve. And I, I feel that this is gonna be also the same for you. Uh going back to this just to touch it about again about this. I've known amazing messages going through this pathway. Uh I didn't do it that way. Uh didn't work for me but still getting some sort of academic, formal academic training. Uh I think it's is something important. Um uh And I wouldn't have been able to achieve what I've achieved without having that academic training even though it was not through this pathway. So it was uh fortunate to, to complete a massive science in the University of Oxford. And then I continued my studies as a phd student uh associated to the Department of Community Education End um's uh where I'm, I'm basically working on ways to see how international collaboration and the introduction of clinical guidelines can improve outcomes for patient's uh suffer from complex trauma to the lower extremities. And I have two amazing supervisors uh Avelox chain and Profit Active Natural, which have supported me along the way. Uh And I'm really grateful uh to them and for the for the ongoing input, mentorship and pastoral support, but also I made lots of friends and I could, you know, fill up the slides with lots of faces. But on the right, you can see Patch Dinsa consulted from East Grinstead with huge in academia who has mental me and has given me projects and we publish together and it's always good fun to work with just next to Diaz Nika, sort of the Royal Free who is also has a breeder in to see in academia and publishes loads and is grateful, add mentoring younger, you know, trainees and medical students to complete projects on the left. Uh Just far left, it's geo um and Luigi who are friends of mine. And we've also uh we published together extensively and we always, you know, share our feelings every time, you know, a paper gets rejected and then you have to go back and have a look also to another general uh and you get, you know, a bit angry at reviewers. Well, that's where you need friends to call, share your thoughts, take a step back, try again until you get that paper, paper published and remember a mistake or a failure solid, a mistake if you don't learn from it. And I think taking the peer reviewers advice uh into your consideration is always super important, even though you may be a bit angry at them or their views, they have, they usually have a point. And if you correct that and you can go to a different general, that will definitely will be a better, better submission than if you just ignore your peer reviewers. So looking back at this learning curve slide, we try to share how mentorship, you know, and training can really accelerate your process of uh you know, becoming better at publishing. But I want to tell you that most important of all, if you have friends, a supportive family and good mentors, it means that you will never be alone. Uh And this counts for clinical training but also um academia and I think we do it because of this, you know, hypothesis to uh taught this so many years ago. But basically the importance of science and knowledge, you know, because you will see that in the specialty, even though in this day and age, there's a lot of opinions and there's a lot of non research, non research or non science based practice um especially in, in the cosmetic world. So it's really, really important to have strong academic plastic surgeons out there, you know, uh leading the way for better care of our patient's. And this is where I worked. I worked in, you see LH doing Canonical Construction Bart's where on the top, right, where I do my breast reconstruction clinics and we see patient's new patient for that need microsurgery and also Royal London at the bottom, right? My email is there, feel free to drop an email. I'm sure that we will share our details uh with everyone attending. Uh I'm happy to have a chat with any of you anytime. Thank you very much for listening to me. Thank you so much Mr Burner for that talk really, really insightful. I really enjoyed it. Thank you so much. Um If anyone has any questions, please put them in the chat and we can answer them to the best of our abilities. Um Just kick off the questions I had one for you. Um in terms of medical students or trainees are just getting into research this looking to do maybe their first or second project. Um For me, I always looked at doing um reviews or systematic reviews um because you could mainly do that kind of at home. You don't have to go and collect data and things like that. Do you agree with that being a good strategy to begin with or not? Yeah. Well, I've published a good number of systematic reviews and systematic reviews. Uh if you have the right training and the right understanding on how to write a good systematic review. Uh and you understand the methods involved and the prisma guidelines, it's not difficult to, to assemble a team and, and, and do a quick uh one other quick but do a systematic view about any subject as long as has not been done recently by anyone else. I can assure you will get published. Maybe not in your first general submitted, but maybe the second or third, usually I have had no promise publishing my systematic views. Most of them have been published in the first general have submitted uh them. Uh And I would only say that it's good if you're starting and you're keen to try to get a lot of responsibilities in terms of learning how to do, not just design of the study, but also the screening data gathering and hopefully writing. But have someone seen you're on board that has done it before because if you get stuck, if someone has done it and seen it before, you will get, you know, out of that uh problem very easily. Mm OK. Yes. Thank you for that answer. Um And uh one other thing I was wondering is that you seem to stress that mentorship was really quite um like probably the most crucial thing when starting out in, in publications. Is there anything else that you'd like to sort pinpoint as being extremely important when starting out to try and publish research. I would say mentors are important. Um But mentors won't come to you. You know, you have to go and look for them. So if you start working and, and, you know, you usually people know who are the ones that are publishing or the trains are publishing more frequently, approach them and ask them for a project, you know, just be open about it. Tell them I haven't done if you haven't, maybe you have done a lot of research in medical school but people that haven't go to them say I haven't done any research at all. I want to learn, I work, I work with you. We, we can get something sorted even if it's just, you know, some presentation for whatever a local meeting, uh if you approach to them and usually people that are interested in research tend to be quite open to collaboration. So um I had a few medical students and foundation doctors have approached to be in that way and they've all always have given them projects and uh not all of them finished them, but they want to finish them, they were able to publish them. So I think go out and seek for men to seek for projects be open about it. Um I would say something also something important in terms of collaboration. If you have a brilliant idea, you know, and you think it's gonna be a big thing, do it straightaway, don't waste time otherwise someone else will do it. However, once you've decided which place are you going to pursue? And what, what are you gonna focus on? But you would see that after publishing a few papers, you will start getting more and more ideas of, for publications, share them out, uh, don't keep them to themselves, focus on this. Obviously, if you have a real idea that you want to keep a bit more, you know, uh to yourself or to a smaller team, that's fine. But you have only limited time. You also have, you know, people you love hobbies, you know, you know, you have to enjoy life as well, you have work to do. So if there's something that you're not going to be able to achieve by doing it because you're running out of time, give it to someone else and then usually they will recognize your contribution with, uh you know, uh in terms of coming up with the project. Uh and then you will have another paper to help them out, you know, steal them, you know, in the way, but share your ideas. I think that's uh also something very positive about publishing and, and having an interesting in academia, right? OK, cool. Thank you for those answers. There's a question in the chat um with starting your publishing career in another field to be useful I plastics. Is competitive but publishing in med ed, for example, might be more accessible for students. Medical education is a wonderful, wonderful area. Um And definitely in terms of job applications, I feel that someone has published in medical education, it always looks super good. So even if it's, you know, a completely different area, uh I think it will look good on your C V but also you will learn. So then when you get to polishing plastics, if that's what you want to do, then it will be easy for you personally. My first two or three papers were published in psychiatry because I was doing a psychiatry rotation when I was a medical final year medical student. And I had a good mentor that had good projects and I was keen and I had not had a chance to, you know, get a plastic surgery experience. So for me, it was, you know, I was undecided in terms of career. So I published two or three papers in uh in psychiatry and uh those patients', those, those papers have been site, you know, quite a number of times. I'm quite proud of them. Uh I don't think they're, you know, uh wasting space on my CV. They're just part of what was my story and my career. Okay. Well, thank you so much for uh there's one more question, sorry. Um regarding the climate change and surgery, I wanted to publish something about this a few years ago. Back but no one was interested, any ideas who could be good to approach to do this kind of project? Uh Well, I mean, I'm only happy to be contacted to for a quick chat. I don't, I'm not doing it, you know, as my main career, but I'm happy to share what I, what I did back in the day at the time. It was still kind of not such, it was 2015 to 16. So there was some interest but no one would publish it as a full papers would end up being published as a letter. Um So um I can be contacted and I can try to think about someone who may be best suited to collaborate that so I can let you know Louis in the next couple of days because you're gonna be a rough. I'll pass that message on. Um Another question is two more questions have appeared. Are there any research collaborative is working on an international level for students in plastic surgery? I am working on a well person. I don't want to just about myself, but I'm doing uh an international project perspective on the quality of life of patient's after sustaining uh open extremity fractures. Uh So, is that something you're interested and you're working close to a major trauma center? Feel free to contact me. Um There are, if you go to the R S T N website, uh they have lots of projects always going on Justin, who's going to talk to you, you know, later today he, he's quite involved with the STN. So I think he can tell you that there's many, many projects, you know, there's no lack of projects out there. And uh if you don't find any producer, you like just, you know, come up with something, let us know and we'll see if we can help you. Okay? Cool. And I think this is the last question before we move on to our next speaker. Um Thank you very much for your kind share ing I just have a question. Is it true that we should be looking to publish more plastic surgery papers than other specialties to prove our dedication, especially when applying for plastics posi CST or is it actually better to publish in different specialties as medical students slash F Y one? Um I mean, I think if you already decided that you want to do plastics and that's your passions go for plastics. Plastics is a really wide specialty you can. And if you're publishing the many of you, I met someone there. They told me that from, you know, 30 American, they knew that they want to be pediatric cranial facial surgeons, you know, crane official Plastic. And so it's very specific, but most of us you fall in love with the specialty and then as you go, you end up in a kind of a niche area. So plastics is white quite wide. So if you want to do different, producing different areas, you can do oppressed lower limb kind of neck, you know, cleft. Uh But if you know that it's plastics is your things stick to plastics. I think that's uh better use of your time. Uh And if you're not doing plastics, you can, you can do do medical education or other more general terms, leadership, you know, there's so many things you can do. Um So don't, there's no fixed rule. And once you've learned how to do research, you will see that it will be easier to then publish more about a particular area in the future. Once you've got the right skills. Okay. Well, thank you so much for your time. We really appreciate it. And thank you again for the excellent talk. So I think what we'll do now is um uh pass on to Martyr who will introduce our next speaker, which is just in worm hold and, and yes, I will let you do that, Marta if that's okay with you. And I will put the, I'll put Mr Burners email in the chat as well for everyone. Okay. Yeah, sure. Thank you. So, our next speaker is uh Justin who is a National Institute for Health and Care Research, doctoral research fellow, a phd candidate in musculoskeletal Sciences at the National Department of Orthopedics Hematology and Muscular Skeletal Sciences. So the end dorms that the uh that was mentioned before, which is a part of uh, which is one of the departments of the investiture of Oxford. So justice research focuses on understanding and preventing surgical site injuries since surgical site infections following surgery for hunt and risk injuries. Um, he's a trainee lead for the reconstructive surgery trials network. The RSD N that, uh was mentioned before as well as well. He's an associate surgical specialty lead for plastic enhance surgery for the Royal College of Surgeons of England. And uh it's just an eye. Are you here? Okay. Um Sorry if you could give us a second to figure out how to put Justin on stage. Yeah. Mm. Louise. Would you be able to commute? Um Hi. Can you hear me? Yeah. Would you be able to adjusting as a speaker? I'm not sure if uh let me just find him. Hi. Can um do you, are you on you Mr Wormald or? Okay. Okay. How about now? Yes. Uh sorry. Um use it Louis. I'm on meat now. I can hear everyone. Okay. Cool. So do you wanna, sorry, Justin, we're trying to figure out how to add you, but the list this refreshing I think, I think you're, you're ready to go, Mr Were mold. Okay? Cool. Um I think you're on the speaker's panel. So um you're if you're happy to go ahead. Yeah. Very happy. Thanks Martha and thanks Louis. So morning everyone and I just caught the end of one's talk. I know how so big big act to follow. But thank thanks very much for the invitation and it may well be, I mean, quite, I do quite similar work. So it may well be that we cover similar things. But hopefully, um, you'll still find interesting what I'm gonna say. I, um, I can see there's about force people here, which is a great audience and I, you know, this is going to be about really about my, my path in academic plastic surgery. And I thought when I was doing this talk together about what I'd like to hear, I guess at kind of medical student foundation year CST level. And I thought basically I'm, what I'll do is just be really, really honest about what I've done and how I've got there and the lessons that I've learned and then you can basically take from that what you, what you find to be useful and I'm gonna sort of chop it up and there should be some time for questions, you know, throughout the talk rather than doing them all at the end and we can have a bit of a discussion about it. So, um, yeah, I'm gonna start, I'll share my screen. Uh, so if you can see that, um, what I'll do is just start my timer as well. Yes, we can see it. Thank you, Nick. All right guys. So, um, starting off with the introduction, I suppose. So my name is Justin and I'm a plastic surgery registrar. In the Oxford Dina Re uh I'm an academic clinical academic trainee. So the first thing I'll say is that my um this whole presentation is gonna be about clinical research. It's not gonna be about basic science research. I don't have any background in basic science research apart from a kind of a four week projects I did in medical school. Um but I know lots of basic scientists and if that's what you're interested in, then, then let me know I can probably get in touch with someone. But this is gonna be all about clinical research and, and my journey and clinical research. Okie Doke. So this is the contents of the, of the talks morning. It should be about 30 or 40 minutes. I hope it's really easy to just spend a lot of time talking about yourself. So I'm gonna try and rein myself in uh so that you guys have a chance to ask questions and talk. Uh Yeah, roughly 33 parts. So where I am now, how I got there guessing to where I am now and what I've learned from that and we'll stop after each section and, and have a chat. Hopefully. Okay. So um let's start with this then. So this is gonna be um a very quick run through my current CV to give you an idea about what I have achieved um to date, hopefully, that will be useful for you. So I am an N T N plastic surgery registrar. That means I've got a number training number which will see me through to consultants. Six year 20 programmers. I'm sure, you know, and I'll talk to you a bit more about how I got that number later as it stands. I've got 79 peer review publications of anyone pub med. Um, I've presented my work at 60 for conferences. Uh I've got nine national international prizes associated with medicine, the plastic surgery. Uh and I've secured over 2.8 million lbs in funding for clinical research in my career so far as, as part of teams or as an individual. So those are the kind of key headlines about what I've achieved from an academic point of view, clinical academic point of view up till 22nd of April, 23rd of April, we are 2022. I'm also kind of affiliated or associated with these organizations that you'll see on the right. So I'm the lead for the reconstructive surgery trials Network, which is the big, you know, previously national um trainee Research Collaborative for plastic surgery in hand surgery, but we're now international and deliver international studies um across the world. My research and my training for the last few years has been funded by the National Institute of Health Research which has just changed its name, mask, got that right in the injury. Uh And that's basically if you don't know about the NIH, are they're basically the kind of Department of Health uh governmental um research body that funds um predominantly clinical research. Their remit is roughly, you know, if you're gonna do a research project funded by them has to deliver patient benefit within five or 10 years. So it's really at the kind of bedside end of, of research rather than at the bench side. I'm a member of religion surgeons. Uh and I'm the associate social special lead for plastic surgery in hand surgery along with two other colleagues, I'm the patient and public involvement leaf the British Society of Surgery for the Hand. And I sit on the research committee for Back Press, the British Association of Plastic Surgery. So these are my kind of current roles I suppose in, in current CV, in terms of, you know, the rest of life. So, um this is a nice picture of Oxford. So I live in Oxford. Currently, I moved here full time in October 2020 that I've been coming here since October 2017. Really? Um And, you know, we recently bought a house in November of last year and fully moved here with my family and it's a lovely place to live. It's a beautiful city. I'm originally from London, uh from North London place called Muscle Hill and Highgate. And I always thought I'd stay in London forever and be a Londoner and I thought I did get my number there and, and work there and become a consultant there. But So when I got the academic job in Oxford, I thought, you know, that's probably quite a good opportunity not to miss. So kind of moved here and actually, really, it's a lovely, lovely city to, to live in, highly recommend visiting or, uh, training here. Um, I've got a wife called Becky who's, um, she's a lawyer. She works in the city in London and I've got a one year old daughter who is, they're sitting on a hay stack on the left and yeah, it's her birthday, first birthday last week. So that's quite exciting. Um And that's tightening quite well with, with my media, my phd, I've had a lot of time to be around um in her first year of life, which would be nice. Um So continue on the theme of things outside of, of work and where I am now. So, um I'm passionate about a couple of things. Surfing is probably my main pash in. Um and I try and go surfing at least three or four times a year at different parts, either in the UK or abroad. And indeed that picture in the middle is me surfing in um Waikiki actually Rock Piles Beach which is in Honolulu and Wa Hoo. So we went to Hawaii in our honeymoon right before COVID in February 2020 and had an amazing time. But that's my real passion in sports wise, outside of, outside of work point into cars. So that's my car I bought myself and I got my number still going strong and I'm also really into food and wine and cooking. Um I've been doing loads of cooking recently, uh particularly the last year and that's becoming increasingly a big part of my life. So, um that's a kind of brief overview of who I am, I suppose and where, how I got to where I am so sorry, where I am example, not where I know how I got to it. And then is that when I picked these slides together, it seems like um you know, everything looks quite rosy and it, you know, it is very lucky in many, many ways, but a lot of these things have, have come as a result of a lot of hard work over the last uh I guess 10 years and it's not all been surfing and cooking patella and just racking up papers on the side. It's been a lot of hard work and it's actually uh I'll go through that now. Yeah, a noise when people show these pictures of how great their lives are without any context and like just be aware, there's lots of context about getting to this point and, and all these things and there are lots of challenges which I'm fully aware of in training. Um you know, particularly the UK, but also abroad that I faced, maybe we can talk about some of those as we go through the next section. Okay. So getting here, so my clinical academic career in plastic surgery started here, University of East Anglia, Anglia, which uh lots of people confuse you ea with you. A United Arab Emirates. It's not particularly in the medical school. It's relatively new. Um And I, so when I, when I was at school, I applied to various medical schools. You could apply to four at the time I applied to you a, a uh Newcastle Peninsula and Southampton, they all had new, new courses. And I was quite keen to do a, a new style course and three of them, but I also was keen to take a gap here and go traveling for a bit. So I said I wanted to apply for a divert entry place and three of them just said, no, just reply next year when you, when you want to come and you said, no, we'll interview you for a different entry place. I interviewed them and they got the place. So uh I went off and traveled and worked for 12 months and then came back and started here. And I don't if anyone's from knowledge or nose knowledge, but it's a really great city again, really awesome place to train and to learn just to live, mitigate quality of life, beautiful to coastlines, uh an incredible countryside. And I highly recommend it if you want to work there or visit there. The course was a PBR based course. So I saw my first patient in my first week of medical school, pregnant lady and all the way through. And I kind of got it the passion of surgery and surgery and I wasn't sure what to do. Like general surgery. I liked plastic surgery. I liked breast surgery. I liked all sorts of different things, orthopedics. But it was really, remember when I was doing a breast surgery attachment and I spent time in clinic with a guy called Andrea fetus, who's this incredible guy. Um you know, what's in Sardinia? And he was doing a breast reconstruction clinic. And I went along and I just saw these women who had been, had, had undergone mastectomy and had this kind of quite mutilating surgery and he had basically reconstructed their breasts and just given them a whole new lease of life. And they came in and they were just so pleased with the work he done for them. And I just thought then like, oh, wow, you know, this, so this is a social, especially where the primary focus is restoring really quality of life and later, you know, function the things like hand surgery. But that really appealed to me. Um And it, and it still does and that's when I really decided on the stoop plastics. And when I started building my CVS is sort of 3rd 4th of medical school. I I decided to interview late and you, we offered a interrelation in the Masters and health research and embraces um, I took advice from various people um, as to whether it did to do A B SC and asked me or surgery or to do this masters in, in London. Sorry, in U E A. And everyone said, you know, it would be great to go to London for a year. But also getting a master's is, is really useful for your C V. It's, it's a higher degree than a B SC and it was certainly good stead. And so that was from a CV point of view. That's why I made that decision. But actually, it was definitely the right decision. It has set me in great stead for the rest of my career and actually just learned loads about research methods. During that masters, I learned how to do systematic reviews, which I've now done quite a few. I learned about basic medical statistics, different types of research. It really gave me that passionflower for clinical academia. Um So that was a real turning point for me and my career's, but particularly as do with academic surgery. So I graduated with the MRSA and the M B B S in 2013. And I started work, I thought I was working before in medical school. But then I realized actually when you start foundation, you get a new idea about what work is um when you stop being a student. So I had a kind of very medical f one and I was, I did cardiology at Central Middlesex, I went to Northwest Thames London, which I don't still exist anymore. But Northwest London, I did cardiology. Uh then I went to Norfolk Park, did community medicine, which is kind of like GP but based on hospital and I came back to Central Middlesex and did general medicine care of the elderly as it was then. And that was slightly challenging because obviously a new one to do surgery, but I didn't have any surgical jobs. And therefore that was a bit of a downer. But I actually just used the opportunity to take my community, community medicine job to do my part a of the mrcs. And that was something that again, that someone advised me to do. And again, I would strongly recommend. Um but yeah, I learned loads that medicine, we had a really small group of F ones that like central mid. And so it was really good, socially as well and really good fun. My f two was 26 month jobs. So the first six months was a Andy of Saint Mary's, which was absolutely um firstly, the best job I've ever had as a doctor, I really learned what it was to be a doctor during that job, but it was also absolute brutal, uh really tough rater, really intense training, saw loads of trauma, loads of surgical pathology, loads of medical pathology. And it was like, you know, it really put hairs on my chest as they say, uh, so going into vascular surgery after that felt like a walk in the park, even though it's basically one of the hardest jobs in Dean Ary vascular surgeries in Mary Colter Neri referral centers. So people were coming from all over the UK to have their operations or interventional radiology procedures done there. And again, that was in credible surgical job. They just taught me real fundamental basics of surgery. And yeah, it was intense and I did a lot of on calls, general surgery, but it was hugely rewarding. And yeah, I just thought it was, you know, I found an incredible year, really, really hard but, but really rewarding and it set me up well, I mean, I did my, so I did my part B in F two and that meant that I, when I applied for CST, I was very competitive and I spilled my first choice job. I think I came eight in the country for CST. At that time. I didn't have many papers and things, but I did well in the, the interviewer exam and I have my part A and I've done my part beat. So that was made me competitive. So I got my first choice job. So sorry. So, yeah, just to mention that. So I was a full member, the Royal College. So just by the end of F two. So I've done part A and part B and that's important. Um I think for my career and it's something I would recommend you try and do if you can. So CST has very, already kicks off from a surgery point of view. By that time, I've become very interested in pediatric surgery of a career, an alternative career choice. And therefore I was very keen to get both plastic surgery and pediatric surgery in my first year, of course, surgical training. So I could be sure about which career path I wanted to go down. So around 2015 2016 now. So I started at Chelsea and Westminster did the whole first year of Chelsea Westminster. Four months, plastics, four months, emergency general surgery, which is basically being on call every day, general surgery for four months and then four months, pediatric surgery with general surgery on call. And yeah, I mean, it was incredible, uh, eye opener in many ways. I mean, I told you about my first experience of plastics, which is best for construction. I read lots about it, but it wasn't really until I worked as an Essex chairing plastic surgery that I realized what the job was. And the fact is the job is 80% hand trauma. And I hadn't even really realized that plastic surgeons did pound trauma. I thought it was kind of orthopedics or any. But yeah, I mean, I was running around, you know, for 12 hours nonstop, no breaks, dealing with adult pediatric and trauma and then various other things as well that Chelsea so that was really important. I open up for me in terms of choosing my um kind of a career I did um four months a general surgery again, was amazing from a surgical point of view, loads of pathology, loads of actual independent operating, running an operating list, which is really useful. And I did my four months of pediatric surgery, which I loved, I really loved pediatric surgery. Um, again, very, really great surgical specialty, uh interesting operations, but very medical. And in the end, that's what put me off. There was lots of, lots of looking after patient's who didn't really need operators but very intensive pediatric medical input, which you would deliver. And for me, that wasn't really what I wanted from my career. Um coupled with the fact that I met this guy at Mary's when I was in any, uh he was a senior registrar at that time. He's consulting how Imperial Frank Henry. He don't remember who I am. But remember this moment being there have referred him a patient. He came down to see the and I said, I'm, I'm really interested in surgery. I think either the new plastics or pediatric surgery. And he said, why don't you pediatric surgery? And I was like, well, I, you know, I enjoy looking after Children and I think it's fun and it's really, I like having that element of my career. He's like, well do plastics, then plastic surgeons do more pediatric surgery than pediatric surgeons do and I was like, alright, okay, fair enough and I actually think he's right when we just do so much pediatric surgery and plastics that that take that box for me. Um So yeah, so that was Chelsea did loads of burns as well. I got really interested in burns surgery. Um but with some really, really important mentors for me and generally just had an incredible time at that point in my career, we have to do matching. Um Then, so you do another like mini interview for CT too. And I secured again, I got, I think I got my first choice. Uh it was six months of plastic surgery. They were all free, which has been recommended to me and my God, it was amazing. You know, I was working for a guy who did um predominately did uh facial animation surgery, adult and pediatric. So he's really complex micro surgical cases, taking free pack minor, um neuro ties, peck minor, uh free flaps and putting them into the face of a child with any facial paralysis to kind of reconstruct their ability to smile and then taking free platysma flap again on branch of the facial nerve and then putting it around there. I so that they could blink. And I mean, these are some of the most incredible operations I've ever seen to date to this day. And it was, you know, proper microsurgery in credible work. It was really privileged to work for him for six months. Uh And then of course, you know, around those elective cases, doing all this on core work, which is again, lots of hand trauma, operating very busy but very, very rewarding and looking after complex cases so highly recommend or all free. And I then went and did my, you know, you usually have to an orthopedic job, but my orthopedic surgery job happened to be a great Ormond Street. So again, it was incredibly experience working in the hospital. There's no Andy, so there's no orthopedic trauma. It's all elective, pediatric, complex orthopedics. Um And I had just great, great trainers who let me do lots of operating and seeing these conditions, you just don't see anywhere else in the world. It's just a beautiful part down into working as well in the beautiful hospital, great canteen. Uh So that was CT to and and sort of towards the end of my Royal Free job before I went to Great Ormond Street. I'd applied for an academic clinical fellowship and I did my national and then so I got the academic clinic fellowship in Oxford. Um And if you get one at S 33, then you still have to do the national selection interview and benchmark. That's would be a point toble. So I did both those things during Royal Free and I had a really good team of trainees. We're all going for it highly competitive. Um But actually worked really well, because we were able to work together to get our numbers and everyone got a number. Uh he works the role free that year. This is the N eye chart integrated academic training pathway. If you don't know about it, then you need to. So this is basically in the UK, the funded um pathway for people who want to do clinical, they make research in various specialties and it basically runs alongside standard training, which is ct ones to, you know, maybe 63 then S T three up to ST eight and you have different blocks of training alongside that which you can apply for. And the most important one really is for you guys, I guess is the academic foundation program and then the academic clinical fellowship and the A C F is what I got and that basically gives you a number S T three. Um uh and then that, that number carries on until ST eight, you get three years in the first three years, ST 34 and five, you get 25% funded research time. So you do that how you want to take it as a block or you do idea which is take it one day a week and work on your clinical academic research portfolio alongside your clinical training. And that's what I did and um highly recommend it. Uh This was the competition ratios when I was applying. So plastic surgeries there and it was about 3.7. So nearly 4 to 1. Um, and it usually sits around there somewhere. It's not the most competitive pediatric services, more competitive, quite a bit more competitive, but it's, it's basically up there. Um, and I think you probably are aware of that anyway. And then point me telling you that everyone knows fastest competitive. So I scheduled the ATF and I spilled my number and I started work as a plastic surgery registrar, clinical academic, plastic surgery registrar in 2017. And I did three years at State Medical Hospital. Um, ST 34 and five, as I said, more or less four days a week doing clinical one day a week, doing research and I did full on call rota. Um, so I didn't, so if you're squeamish or you just had breakfast, then you might look away some gruesome pictures coming up. Now, I just want to show you the kind of clinical work that I, that I do or that I've spent the last three years doing. So, as I said before, vast majority hand trauma, I said it's 28% of the work, um, so severe, you know, obviously these are some of the most severe injuries that you might see, but lots of now there's lots of pediatric injuries, increasingly, lots of kind of quite minor injuries as well as these more complex injuries as any gets fuller, more stuff just gets shifted to us. And they're doing is like less of the minor stuff that we used to not see, but that's fine. It's all good operating. Um, and it's really great in Virginia trainings to do those kind of cases. Lots of burns, unfortunately, loads and loads of pediatric school. So it's one of my things I used to see, you know, every day or two because we were burn center, a burns unit story. So we take referrals from the whole region for burns. Kids reaching up putting down hot cups of tea unto themselves or pots uh pounds off the hub, boiling water uh getting really kind of severe recess injuries. Um So over over 10% injuries and Children which require a mission recent resuscitation. So it's really sad. Uh Lots of lots of hand burns and kids from touching hot stoves or uh wood burning stoves or anything. Then of course, we'd see severe um adult burn injuries as well as we take up to 40% burn injuries. I just did loads and loads of burns recess got all of my numbers for burns recess. Let's take an Advil and loads of burns operating. Um So that really builds on my experience in Chelsea and and was very hands on and then of course, uh lots, lots of skin cancer. So we did lots of SEC BCC uh surgeon, local anesthetic. There also lots of lots of melanoma operating so wide, local excisions and the auxiliary um clearances and inguinal clearances for lymph node disease. So again, proper general plastic surgery and fantastic operative experience, then I can recommend it highly enough. And these are the sort of things you want to be doing in your S T 34 and five. Lots of skin cancer, lots of antrum, lots of burns. So this brings me up to where I am sort of now. So I'm now doing so I did S T 34 and five. And then I, during that, during that time, I worked as my A C F building, my, my clinical academic portfolio and applying for funding to do my phd. And if you're interested, I'm going into those details about how I got my funding for my phd. It's quite a long story, not very long story, but it's quite detailed. And if there are questions about it, then we can talk about it. But essentially, I'm now funded by the National Institute of Health Research. As I said, I work predominantly in the Kadouri Center which is in basically above A and E in the John Radcliffe Hospital in, in Oxford. Uh And I also work cross site at the bottom research center which is where end dorms enough department of rheumatology and must go schedule sciences is based. And that's where I do my research clinically. I do locum shifts at stake, manage all doing trauma and burns and things as and when. But I'm primarily a full time researcher at the moment. Um And on that topic. I suppose this is really where I am now. So my, my default is entitled Understanding of Preventing surgical site infection following surgery for hand and wrist injuries. This is a little screenshot of my page on end dorms which just shows you a bit about what I'm doing and what I'm up to. Um the primary crops of my phd is, is clinical trials in trauma and reconstruction, which is what I'm passionate about. And so my phd, I've got various projects with a primary project is that I'm running a randomized clinical trial of antimicrobial coated sutures compared to standard sutures in any patient that needs surgery for a hand and wrist injury. So that could be uh open reduction, internal fixation, a plate for a distal radius fracture, it could be effects tend to repair, it could be a replant of a hand or a finger. All of those patients are included in this study and it's running at two sites were about to open the third site. So far randomization is going well. I'm also doing some epidemiology around wound infection in upland trauma and um some work on patient person outcome measures uh as well as a massive systematic review of 150 studies. So those are the kind of projects that sit around wound infection of clinical trials and trauma and reconstruction. These are some trials that I'm have been involved with and or I'm currently involved with. So the Ninja trial, which you may have heard of if you need to know about that fuel plastic surgery, general knowledge is going to be published soon. Hopefully, the BMJ, just looking at management of nail bed injuries and Children, the Neon study part of the group, the team for the Neon study. And that's looking at whether we should surgically repair, stitched together digital nerve injuries or whether we should just wash them, line them up and leave them to heal themselves. Um These are two ninjas finish. Recruitment. Neon is actively recruiting and it's something you can get involved with. If you're working in the UK as a hospital that isn't currently doing it well, then if they are currently doing it, something you can get involved with. Hawaii is my study. So that's handled. This trauma has microbial switches, an infection. And I told you about that already. It's 100 and 20 patient's across three sites. Again, you can get involved if you're working at one of the sites which are Corn War, Oxford and State Mandel Flare is a new, a new study which is gonna be opening later in the year. And that's beautiful logos and be a martyr. I'm hoping that's going to be adopted as the, as the logo, uh stiff competition. But this is a really interesting study looking at whether we should repair when you cut your flexor tendon, whether it's repair both tendons or we just repair one of the tendons and see which one gives you a better function. So really my main interest is it is in within clinical academic plastic surgeries in clinical trials and associated methodologies. The other part of my phd is that I, I'm a tutor, so I teach the clinical medical students at Saint John's College where I'm affiliated. I usually have about six or seven students a year and I teach them all aspects of clinical surgery, not, not plastics, but all surgery. And my, my group that I've been teaching it last year all past the finals and did one surgical cases which I'm pleased about it. It's really nice to be part of the college life in Oxford and John's have been very and helpful towards me and, and towards the medical students that I teach. So that's a little overview of um who I am, I suppose and how I got to where I am and what I think I'd like to do now is maybe um I'll stop sharing for a sec and um take questions and then towards the end of a lot of time, I'm going to go through what I've learnt. So um so um uh yeah, so first question would be actually from me. So the previous talk we actually um uh Mr Bernard actually mentioned about the R S E N and we had uh questions about the R S E N itself selling a little bit more. What, what exactly um uh what exactly is our STN and how to get involved. That's interesting. You should ask Martha. Um, so I'm, I, I was going to talk about that in the next section. Um, yes, the reconstructive surgery trans network, I've mentioned it already. Right. So that we might as well talk about it now. So if you're interested, if you're a trainee, any level for medical student, up to senior registrar, even consultant, then the R S T N is basically the organization that hosts medical academic research for, for trauma phenoms, trauma for plastic surgery and for and for burns. And so if you have any interest in, in, in anything they've been talking about and go to the R S E N uh sign up for many less our social media accounts and get involved were a bit like, I guess you may have heard of things like Star or global surge. These big collaborative were basically that plastic and hand surgery and actually some of the things that we're doing and large China are more advanced and innovative than some of the other social cavities are doing. And that's recognized by the world religious surgeons who, who are fans of ours. And often give us a shout out to what we're doing. But basically our skin is where you can go to do research, get involved in training, training, collaborative research, learn about research. If you don't, you just learn, if you might be interested in it. If you are interested then more about how to do it. Um And also just hear about events and things are relevant to plastic surgery and research. We've got an incredible committee of about 20 people of which martyr is one. And there's, you know, our committee is set now until July 2023 until next year, but keep an eye out for committee positions. There's a national committee we're always looking for, for new enthusiastic members to join our team. Yeah, I've got the Lynx and everything to the R S T and I'm an ex set of slides. So don't feel like you need to look at it now, I'll put up there and you can have a look at your own uh in your own time. Thank you, Justin. So it was you're muted, Marta. Yeah. Another question about uh how you secure your phd funding. Yes. So this is a really, this is a real uh this is a long road. Uh So the National Institute of Health Research has these doctoral research fellowships which are basically funding streams for people who want to do basic clinicians who want to do clinical academic phds. Um And I was already funded by the NIH are as an academic clinical fellow. And the logical step is to then apply to National Institute. The NIH are for your phd funding. And we had a good track record of success in, in my department. And um I've worked really hard on application and it was looking positive basically. And um I got shortlisted and about 10% of people who apply get shortlisted. And then about half of those uh shortlisted for interview. And if you go to interview, then it's better odds. About 50% people go to interview, get funded and they got shortlisted. And then um got my interview and then COVID hit and because the National Institute of Health Research is funded by the government, almost all of the government funding for research was diverted to COVID research. And therefore, unfortunately, things like hand trauma weren't gonna get funded. And although I got uh scored highly and basically deemed fungible, they said, I'm sorry, you know, I haven't got the funds this time. So you have to reapply which is a bit of a kick in the teeth. But you know, these things happen and you can learn a lot from when things don't go well, probably more from when things than when things do go well. So I was like, right, OK, we'll find the alternative options. And actually, I've taken advice and I'd already applied for other streams for funding just in case it didn't work out. So I applied to Royal College of Surgeons, um who um and the bridge doctor says you found and I actually got those grants. So I was able to start my phd on rcs funding via the blood back in the Institute Research Foundation. And uh this age and I'd also secured a departmental, um, and Saint John's college scholarship. So that covered some of my living expenses and, and the cost of the actual phd. So I was able to get myself through that first year. I reapplied for the H R granted, got it to fund my second two years. So, um, it was all fine in the end. But, yeah, really. I ended up applying for the N H R twice RCs PSSH departmental ones. And so I know the process very well and it was extremely useful. And if I just got the child, first time around, that would have been, it would have been great, but I wouldn't have learned or experienced any as much as I have done now. So, uh, that's a good lesson about failing. Sometimes it's really important and you get more from it. My A C F was, uh nationally funded. Okay. Thank you, Justin. So I think that's horrible. This session. So obviously being mindful of the time if we could proceed to the next path. Yeah. So this is about what I learned through the whole process and, um, hopefully this will tackle some questions you might have, it might or might not have, might not thought of. So what I would say is whatever level you are, if you want to do clinical academic surgery of any kind, you really need to start. Absolutely. Now it takes ages to get things published much longer than you think so, just start now, like today this afternoon, start making, making preparations or start doing things to start your career. It's not something you can sit around and think you might decide later when your foundation doctor, of course, surgical training or a registrar, you need to start now. Uh And that is why I've been able to achieve what I've been able to achieve because I started relatively early and I've consistently worked on things. It's not like I've been, I did it all in six months. This is really important. You need to keep track of everything you do and it sounds obvious, but just create a CV with your career to date with the dates, the locations, your supervisors, publication presentations, prizes, funding, and just keep that update every month because it's very easy to lose track. And it's just, it's just absolutely madness to do something and then not, not put it forward when you're applying for jobs. So just make sure you keep track, keep all your certificates, you're gonna have to put forward a portfolio at some point. So just make sure you just keep track of everything. This session, everything. This is a perfect example of session. You know, it's important if you say if you're a medical student or foundation doctor, you belong to this session. And you can say in two years time when you applied for a CF. So, you know, I've been committed to an academic career plastic surgery. Here is evidence of a session I went to um back in 2022 where I heard about these things and this is why this is what stimulates me to do this. That's, that's compelling to an interviewer. So please start now and build your CV. I'm happy to send people a template. Uh you know, a copy of my C V. If you'll use that as a template and build on that, this is really, really important as well. So if you want to be a clinical academic, then you have to be one of the best clinical people in your peer group, you've got to be the best clinically to be a good clinical academic because you're gonna have to achieve the same amount of things in less time, think about the academic clinical Fellowship. So that's 75% clinical and 25% research across three years. ST 34 and five. But I had to achieve 100% of my clinical competencies in 75% of the time. So I have to be more organized, do more operating, do more clinics, see more patient's critically, as I said, be more organized and make sure I recorded everything so I could take my, my yearly milestones. So um you have to really work hard clinically, a good example. That's something I've already mentioned to do mrcs as early as possible, be as congested as possible. Have a surgical log book. Do all your boring foundation. On course, surgical trainee sign offs as early as you can. I know it's boring if you're doing A I SCP um in the UK. But you just got to be on it. You got to be the best of the clinical trainees to be a good clinical academic trainee. Um, when I applied for the A C F, remember Don Furnace saying to me, you know, yeah, it's 75% 25 but actually it's 100% 100%. You've got to be 100% critical anybody. 100 academic and that's reality, the think academic career and, and that puts you off. That's good because it's really, really hard. So you should only go into it through, aware of the fact it's going to be a real slob but then equally, it's incredibly rewarding. This is one really, really important thing both for you and for how people see you. Uh and how people will react to you in terms of opportunities. If you're given a project, must finish it. So every little project you get given every audit, try and publish it, try and present it and try and send it in for a prize or write an essay about it for a prize. If you do that, your CV will build. If you don't do it, it won't build. Um So it sounds obvious again, but just make sure you finish everything that you start and um don't be one of those people that gets given opportunities and doesn't finish them. I have people like that and unfortunately if I give someone a project and they don't finish it, I'm unlikely to give them another project because they haven't finished the one I gave them before. Um, I just don't think it's going to be valuable to anyone. So be a finisher, be someone who finishes projects that they're given, even if it's a slog, if you're not interested in it, if you've been given it and you said yes, then then do it. And that's an important lesson for clinical work as well. You know, in general, just be one of those people that gets things done, whoever hard they are typically and don't be free to ask for help. It's much better to ask for help and get it done and not ask for help and, and, and not finish it and just go off the radar. Yeah, this is a kind of slightly lame comment and get yourself out there. What I mean by that is start making building your network and creating a group of mentors or people who can support you. And um if you don't know where to start by finding people who are interesting, clinical having surgery, plastic surgery, then yeah, hit up the R S T N. So this is the the surgery trials network. There's our website, it really is defined on Twitter. So please follow us on Twitter, Instagram. Maintain. And, and I think what would be useful for people on this on this on this course would be to have a listen to our podcast, which is um on Spotify and Search for surgeons are trying to put together by Priyanka who's one of our, one of our committee members. And it basically gives you really good insight into clinical academic surgery and plastics. And um, and I highly recommend just listening to the intro ones and some of the expert panel ones about the different types of research to do and why. And that will tell you more than I can tell you in this session about why it's useful, why it's rewarding and why it's important and the house get involved. So, yeah, big plug for the podcasts. They're only about 20 or 30 minutes each and they've been really well put together. This is my kind of con ultimate slide really. But these are the people that have supported my career since very early days. And without these people, I wouldn't have achieved what I've achieved. I wouldn't be where I am and I wouldn't be passionate about what I do. So make a mental snapshot of these people. If you can get to work with these people, then um you've done well and they can support you and inspire you to become an academic plastic surgeon. So I'm gonna do a few specific shoutout. So Matt Costa is my, he's professor orthopedic trials in Oxford. He's my phd supervisor that's Jeremy are both clinical academic, plastic surgeons. Matt founded the R S T N with Abby Jane is a professor of plastic surgery Imperial. Uh these guys are really, you know, absolutely incredible mentors and supporters. Um clinical academic plastic surgeon. The UK, Adrian Grobler is also um he's a professor now who writes in Bern in Switzerland. But he was the guy I work with the Royal Free Deborah is what is a professor, orthopedic Children, orthopedic surgery, quick Norman Street. And she supported me a great Ormond Street when I worked there and it's a good friend. Now, Dom is head of School of Surgery now in Oxford and he is a professor of plastic surgery in, in Oxford. His work is predominantly in genomics, basic science, but he also does a lot of clinical research and there's a great epidemiologist, Declan John done. I put together because I work with both of them in London and they're both great friends and um definitely in credible burned surgeon at Chelsea and has a great app clinical academic mind. Jonathan is a new uh skin cancer consultant, particularly focusing on head and neck at Charing Cross and is an absolute legend and also has a great another academic mind. Rebecca Shirley is an incredible hand surgeon at ST Mandeville who also does loads of those microsurgery. She's been an incredible um surgical mental to me at the last three years. Aboriginal mentioned pressure plastic surgery and co founded the R S T N and a great guy to know and work with important about all these people is that I would always, I'd go for a beer with any of them any day I could and I wish I could do it more often. They, they're actually great friends as well as great plastic surgeons and mentors or orthopedic surgeons. So I'm going to finish their, um, I, again, happy to take more questions and I think you've got my email in the slide and we got about 10 minutes left. I think. So. Um Let me know if you want to go back to any slides or any questions. Uh Yeah, I've been monitoring the chats. Uh uh huh. Mhm. So, I can see there's a couple of questions. So Sana, why did I choose to pursue a career in clinical academic surgery? Good question. Um For me, academia gives you, it's like having two jobs and for me, surgeries in credible plastic surgeries in credible, but it probably isn't quite enough to keep you really, really enthusiastic and engaged. And the good thing about academia is that it's just a totally different job and it's like having to really, really great jobs instead of having one great job. And it makes it more interesting day. Today, I got a little bit more autonomy in how I, how my week works and I'm able to work with lots of different types of people who otherwise wouldn't do if I was just an NHS plastic surgery trainee so expanded my network, expanded my mind, expands my interest. It's leadership skills. It's, it's intellectual skills and it's also so absolute in terms of my work, it's so applicable to my day to day clinical job that it's just fit so nicely. Um, and I wouldn't do any other way, so I wouldn't, I wouldn't do a pure clinical academic, pure clinical career. I've always from now do a dental academic career for sure. Um, there has been hard though and they're also, you know, I'm not gonna sit here and say that it's all been rosy and I've always wanted to be a surgeon and I always want to be a surgeon when I do. Um, but yeah, it's hard, you know, I faced the same issues. I was there in the junior doctor Strikes Chelsea and Westminster. Um, when I was a CT one and it's hard being a doctor in the, especially the moment. It's really hard being a trainee. And yeah, I've looked at Australia, I've looked at other careers and I'd be lying if I said that I didn't. And I, you know, I think I've got an amazing career in, in plastic surgery. Uh, and yeah, even I look at other options every now and then, but I always come back to it. So I got to say something. Um, I just, I just want to say thank you. For the, the talk really, really informative for everyone listening. And I'll just read out that the next question. Um Does R S T N have any planned projects recruiting for international centers? Currently we do? Um Yeah. So there are various things, there are various R S E N projects that we are doing ourselves and there are also projects that we support. So the one that finished recently, for example, was called cipher. So that was looking at whether we should use Betadine or Chlorhexidine when we're cleaning the skin prior to hand surgery. Um And we had loads of international centers running data for that. So you have a look at our website, look at the get involved sexually, look at past projects. There are loads coming through. Um And therefore it's just important to keep an eye on the, on the mailing list and see what, what's up there. Um That, yeah, that would be my answer cause there, there are a couple now but there will be more. So keep to just keep an eye on the website and sign up the waiting list and social media. Okay, cool. Um The next question, I think you may have answered it a little bit just then how should we approach our STN to look for projects for medical students in London for the summer? So I get going on the website. Get involved. Yeah, I get involved. And also I'd say that you know, Artan isn't in London or Oxford based thing. We are National International. It doesn't matter where you are. Um What kind of sometimes important is that you're working in a hospital because we need to collect data from, from the hospital. Um but not always so just keep an eye out. But yeah, you can be anywhere and do it. And we also, you know, we are the R S T N and with the RCN public were also a group of plastic and hand surgeons who are interested in research. So it's just a great place to find people who are interested in what you're interested in, maybe contact them directly if they work in London, for example, to see if they can spend some time with you. Yeah. Ok. Cool. A lot of people asking for a copy of your CV. That's fine. How best to give it to the people you guys. And I feel like the talk itself was almost like uh your C V in a video form. Really, wasn't it? Yeah. Yeah. Um There's another question here that says, how, how did your, how did you figure out hand surgery to be your clinical interest and research? Interesting. So actually, so I am interested and surgery. I'm interested in all plastic surgery. That's the first thing I'd say. It's probably slightly more interested in trauma than I am in a collective surgery. So I would actually say that I'm more interested in hands trauma than I am I am in hands surgery. But that's because I'm primarily interested in trauma. So I'm interested in burns, lower limb trauma, facial trauma, um, hand surgery's just what I spent most of my career doing surgically and it affects a huge number of patient's, it's just so unbelievably common. There's literally, they're just very few studies that, that can provide evidence for what we do and we're just doing all the surgery all the time treating all these patient's. We don't have a good evidence based for it. And that's why, that's how my, my, my interest sparked in, in doing trials in hand trauma because it's feasible. It's not like some rare disease. It's very difficult to do research on particular, difficult to do trials on. This is like 250,000 operations a year in the UK. Imagine how many massive trials we could do to actually build the evidence for that. So it's a little bit of low hanging fruit, but also super interesting also, it's just great surgery and it's just awesome. I mean, doing surgery is just awesome. So, and doing hand surgery is awesome and putting people back together is what I love about plastic surgery. It's so rewarding if someone comes in, all smashed up, be at their face or their hand or their leg and you put it back together, you know, there's nothing like that. Yeah, I have to agree with that for sure. Um, are there any academic requirements for phd in both medical school and masters. Yeah, I mean, you have to, you have to apply for these things and they're competitive. Um, everything is competitive on a scale. You know, it's not as competitive, getting an NIH our doctor research fellowship, but they still, people are going to take you on unless they believe you're gonna be able to do the phd or the masters. So, having, having some, having done a couple of standalone courses in research methods, maybe if you can get some funding to do that through your medical school. A couple of, you know, case report, a couple of small papers, perhaps a good statement from a supervisor who you can test, you know, testifies the fact you're a good candidate for a master's or phd. It's not super competitive, but you can't walk in either. That's what I'd say. Okay, you need to have a C V which has some stuff on it basically. Okay. Yeah. Um So another question says, can you tell us some tips for approaching collaborative projects and how to get the most out of them? Yeah. What are the roles that medical students can get involved there in committee regional lead? So for the RCN, we tend to, for the executive committee, they tend to be senior trainees or trainees who have a strong academic background, either doing phds have phds or uh lots of complications, for example, but for the rest of committee members, um we don't really have any specific requirements about what level you're at. It's more about your passions or interest in clinical research and actually have a group of a new subsection of foundation doctors who set up their own little subcommittee within the R S T N who were focused on medical student and foundation related um issues for, for reconstructive surgery trials network. So you can get involved at any stage. I think the best what I want when I look to a point, someone's committee, I'd like to see that they've been involved in an R S E N project already. The tips for approaching projects are number one, be aware of them when they come out, which means everything I've said before about their STN number two is if you do turn up to do to be involved to collect data or to contribute, then make sure you finish that and do it well and show an interest and communicate well with us. And that again shows that you're going to be someone who's gonna be good to have on board later in the committee and, and engage with, you know, our social media accounts. Um Yeah, just keep in contact with us. Come to our trial. Got massive. Yeah. So that's a big plug. First of July London Broil Club, the surgeons all day, the first in a while, reconstructive surgery trials day um conference. So it's an all day event with loads of talks. Um if you submit a poster, then it's very likely to be accepted. So, if you need to get post presentation, I strongly recommend you submit abstract doesn't have to be work done. It could just be an idea for a, for a study or a trial. Okay. Uh So it's easy to get in. Yeah, I think we're charging 20 lbs for the day. So it's pretty cheap. There's lunch and you get to meet loads of like minded people. The whole committee will be there some, some really big names and then the Latina will be there. Um So please do come along. Um That's a great opportunity to learn more. Okay, cool. Thank you. Um I think this was, this will be the last question before we move on to our last speaker. Uh What standalone research skill projects do you recommend for students and trainees to take? So you can do um if you find the trainee in your hospital where you're working through a medical student, um There may be one is already part of the Rs in committee or if not, you can recommend someone who works at your place, help them do an audit or, or a small project. And if you can get some funding from your medical school, do a systematic review course because you can do a systematic review in your pajamas on the weekend. You don't have to go into hospital to collect data and actually they can be really important high profile publications. We've got lots of systematic reviews that needs to be done with the R S T N. It's very difficult to hand them out unless you've done some training. So I would say look at the Cochran, I'm gonna put that in the chat. Cochran of Sight. Cochran's reviews that has a, some free online training and systematic reviews. I could load semester views as a medical student because you could, you could access it. You've got Google, you got pub med, you can do the project. Uh So that's a really good place to start. Start building your, your research CV. And it also teaches you how to understand clinical research because you have to critically appraise lots of papers. So it's a really good process. If I see you've done a systemic review, then I know that you understand medical research. Sure, that's a good place to start. Okay. Well, thank you again so much for giving up your time to give us this talk. We really, really appreciate it. And based on all the questions we've had, I think people have really enjoyed your talk as well. So thank you so much. Thanks for the invite and please get in contact with me on them by my email. It's in there or on Twitter, my handle there if you want to get in contact with anything and I'll leave. I mean, I can send you guys Louis in March my C V and you can send it to people who want it. Okay? Yeah, cool. So yeah, you can get in touch with our society and we can distribute that if you, if you wish to look into the C V. Thank you so much again. Great conference. Great. Thank you so much. Bye bye bye. Um ok, so just bear with us for a second. We're just gonna try and get on last speaker for the day to join us. Hello? Hi, it's nice to meet you, MS uh MS. Um So if it's all right with you, I'll just give you a little brief introduction and then if you're ready to take it away, then we'll go ahead. Is that all right? Yeah, sure. That sounds perfect. So can you hear me? Alright, I can hear you perfectly. Yeah, that's great. Ok. Um So MS Chalmers is a senior plastic surgery trainee at the regional Oncology Institute in Yeah, she uh Romania with, with a special interest in burns wound healing and stem cells, which is conducted a phd in Grigore t proper university and a Mary Curie fellowship at Astrazeneca as well as working towards a master's in philosophy at the plastic surgery and burns Research Unit in Bradford, UK. So we're really glad to have you today. Um If you're ready to share your screen, you can take us away. Sorry, just one second. No worries. Uh Perfect. We can see that clearly. So we'll let you carry on Thank you so much. Yeah, so sorry just to bury me one second. Ok, that's fine. Okay. So thank you for inviting me to speak at this event. So, um so they know why? Sorry. That's okay. No worries. Okay. So I will be discussing today regarding the academic part of plastic surgery and focused mainly on the research side. So currently I'm a senior plastic surgery trainee. Um and I was involved in the academic side since the beginning of my training through my Beijing enrollment and also through my teaching um activities as a teaching assistant. So um why uh this topic is because I have a special interest in burns, wound healing and stem cells. And this is because some people can argue that a scar is just a scar. But for burn patient's is far more than that because it involves uh instability scars along with contractors that can um really impact the quality of life. Also, on the other side, the Samson's have a really great potential towards regenerative medicine. Uh does restoring function and improve the outcomes for patient's including the life quality. So my, my career path was a little bit more convoluted because um along the way, I had some really great opportunities such as doing research which will be discussing today, I've done two clinical observers in the UK uh fellowships, including one in aesthetics, also in in the UK. So I think it's really important to um make the most of each opportunity that gets in your path. So in my opinion, both the clinical and academic aspects of the plastic surgery are important because it helps us whenever we have a clinical questions to translate in research, regardless of the type of research that you conduct, and then the results, you can take it back into practice uh with the goal to improve the patient outcome. So um from my point of view, every time you should have in mind and the main target should be um improving um uh improving your version just to help your patient's. So this goes alongside with semin ating information by teaching, publishing and attending conferences. So when I started research, I had quite an unrealistic view. So I I thought that it's all about feeding plan. You go in the lab, you start doing the experiment and then published in reality. Most of the times you can't predict everything. Um And following reading, planning and designing the experiments you get in the lab and issues start to arise. So you have to go back to reading and planning, you have to do a rethinking to adapt to be flexible re plan in order to at the at the point managed to find your way out and achieve your goals. So some examples regarding research and troubleshoot. So we have here um exposing some three D culture models to silver quote addressing fragments if the fragments were simply placed um in the wells the debris is makes almost impossible um image acquisition because you have difficulties in focusing the images uh and the analysis. So the solution was for three D cultures, you can see in the mid uh middle image here just to adapt another type of plate. Um And for the two D cultures just to use some flow cytometer caps, you can see in the middle and the bottom image um and both act as an insert. They are quite cheap, you can do it easily in the lab. Um And then this is the result you get really nice images that you can use them for analysis. Another um issue which can emerge is how to manage your budget. So here is an example because this chambers for immunocytochemistry require quite a large amount of antibody. Uh You have to find a way to decrease the amount because the antibodies tend to be quite expensive. And if you have a lot of them, then it can really impact your budget. So a possible solution wants to use the silicone or rings, which did not work because the solution required to um for the immunocytochemistry protocol alters the surface tension that's not retaining the liquid within the ring. So before running a really big experiment, which again can be really expensive, just try, try different ways and make sure that whenever you run the experiment, everything should work almost um properly. So do trial tests. And in this case, I've done some with water and media. Another issue which can arise is whenever you don't speak the proper method for your target. So in this case, it was the immunocytochemistry and the left image you have some stem cells and the smooth muscle acting uh which is an interest celery protein. And the methanol protocol worked perfectly. Um But because the methanol destroys the cell membrane whenever you want um uh membrane targets such a receptor. Uh then the methanol uh just destroys the membrane. So we had to adapt the protocol and use a mild detergent which was more suitable. I'm also part of the research team at the center for surgical training at the regarded uh type Open University of Medicine and Pharmacy where we do in vivo surgical research. Um and also is the training center for basic surgical skills and microsurgery. So you have, there are crowing flab and then uh we uh used to prepare um teaching material in this case, how to inject the local anesthetic on a nonliving model. So the research, my phd research was regarding one management and and septics because want management frequently implies um antiseptic usage. Um But the current data regarding the antiseptic effects on one healing are quite controversial um when talking about impairing versus aiding wound healing. Um And there also is current available data regarding the impact of cell based therapies on improving and healing. So what about in the event of using both themselves and antiseptic. How would this affect with healing and scarring? So, we chose three uh commonly used anti sub antiseptics, which is the provident iodine chlorhexidine and the silver coating dressing. We used four cell constructs. Um fibro blessing stem cells in monocultures or in co cultures in different selves ratios and also to culture systems which is a two D monocular or uh three D culture using spirit. So we assessed migration in two D with using the cell exclusion essay and in three D collagen is profiting essay. And in the image and left in the right story, you can see for the co cultures that you have different migration patterns whenever they are exposed to uh silver chaotic a quoted tracings. And in the bottom, you can see uh comp occult image regarding how the cells migrate differently whenever they are exposed either to the povidone iodine or to the chlorhexidine. And also whenever was possible, we did a comparision between two G and three G systems. So we found that variation you have with the some type that you use with the ratio, the antiseptic and also the cell culture system. So um to enable the data translation because there's a gap whenever you do in in vitro research and then translating the results in a clinical setup or an in vivo setup. So three D systems uh using more complex models made better mimic the micro environment. So in a cell based therapy scenario, um it may be useful for further research just to assess what antiseptic would it be better to use? Uh in a cell based uh Therapy Association. The Mercury Fellowship was part of an EU project called Eight Pad. So it was a collaboration between, between academia and industry in uh astrazeneca, but it was an oncology department. So I've just decided to take the chance and do the best. So I had to rethink a little bit my interest. So to keep close to plastic surgery, uh and my interest to stem cells, I have chosen Melanoma to do the research because of the stroma heterogeneous et which can make difficult to predict the pharmacological response and find a way to go to go around um drug resistance. So we develop models with relevant salt types um and uh conducted drug testing using two inhibitors. So we used for Melanoma cell lines and again, multiple cell conditions including three cultures between fibroblast themselves and Melanoma cell lines. Uh we also use the steroids with or without the feeding Claire of fibroblasts and we use the broth and making him bitters combination therapy. So what we found was that there is a differential pharmacological response, especially as you can see here for um the three culture conditions. So whenever you have the highest doses of both uh inhibitors, um the steroid shrinks considerably compared with the untreated. And also we've managed due to the feeding glare. Uh of five progress, we managed to do a three D long term co culture. So basically, to assess um and to evaluate and observe uh two more growth and how actually uh the cells are spreading on the fibroblasts layer. And again, as I mentioned before, the three D cultures um promote characteristics that are not possible in a two D model. Um And using more complex models, um it made um better mimic the tumor micro environment. Uh that's making the model more suitable for evaluation and the results that you get um easier to translate in a in vivo or clinical setup. And also uh we uh we can use this model as a tumor growth model. Yeah, regarding the research conducted at the plastic surgery and burns research unit, I was able again to, to um focus on my main interest which are burned and burned, wound management cell based therapy. And this time, I've decided to focus on the interleukin six pathway. So we know we know that um only some cells have boulder sector required for the cells to be responsive to the interleukin six through the classical pathway, which is usually considered an anti inflammatory one. But most of the cells um require the soluble receptor to be responsive to the interleukin six uh via uh trans signaling pathway, which is considered to be more a pro inflammatory pathway. So again, we use to sun lines, fibroblast and stem cells from donors with matching characteristics and for cell conditions. Um differential treatment with the solvable um interleukin six receptor. Uh We used MBD inserts just for the cell exclusion migration essay. But as I've mentioned before, um just before starting your experiments, just try to plan as much as possible. So we had to assess the might um missing concentration for proliferation blocking um the interlocking six levels. And also just to make sure how much receptor we have to give and binding assessment. And then as you can see in, in the graph, whenever we gave their sector um in the wells with the cells directly, there is a rebound effect. So the interlocking level uh increases uh that's with the red line. So we had to to take the super an attempt from the cells, put them in a plate with no cells and redo the experiment just to assess the binding and to prove that the interleukin six is consumed um um through binding with the receptor. And then we assess my the migration and pattern evaluation because in the first part, as you can see where you have on the left side, the fibroblasts and on the right side, you have the stem cells. This condition is usually what happens in vitro. So whenever you do just the simple culture, you, you usually don't add the soluble receptor to the media. The next column is what happens in vivo because you're going to have both cell types exposed to the soluble receptor. And then in the next two columns, you have um depart whenever you can actually influence um uh the cell based therapy. And you can see this is at uh evaluation at time zero and then at 24 hours and there are differences in better migration and also in the uh timeframe in which the gaps closes. We also assess cytokine is and uh growth factors levels and different um receptors and phosphor elated proteins through immunocytochemistry. And what we found out was that immigration pattern as mentioned, they do vary and the cells and you can see here in man gente, there are stem cells and they form some extension, really think extension called Philip o'dea. And also you can see that they form extensions between the cells which requires for the research. But also um what we found is not that uh not also sub population express um that part of the receptor. So this allows you to do a differential management of Celsa population in the scenario where you would use uh cell based therapy for one management regarding publishing because it's quite a important part of the academic plastic surgery. Um All data are valuable. Um No result is a result that should be presented and or published um as it made a data translation in a in vivo a clinical setup. So I've started with my first published paper in 2015, which was a case report and then attended multiple conferences where I have um presented part of the research results. Um and also I consider reviewer activity um can be quite um important regarding teaching is my personal opinion that information and experience should be shared. This teaching is an important part of the academic plastic surgery field. Um And here is a picture with me when I was attending the course basic surgical course as a trainee. And since then, I've managed to be course director for one of the basic surgical skills courses here. I've also attended regional teaching sessions in U K where I've presented with healing uh about when, when healing. So my main my message to take home is both clinical and academic films in plastic surgery are intra intra gated. My advice would be enjoy your work, tackle issues along the way as they come up and make the most of uh each opportunity um and create, just create your own path from my point of view. Uh It matters the goal and the trip and not how long it takes to get there. Thank you for your attention and I'm happy to answer any questions. Thank. Thank you so much MS Chalmers for, for that talk really, really interesting. Um We're really glad to have had you speak to us today. Um If anyone has any questions, please pop them in the chat. Um I just have one question to kick us off if that's all right. Um So a lot of the uh people watching today will be medical students and trainees. Um And obviously the basic sciences and the the experimental laboratory research is the foundation of anything to do in clinics. So I was wondering what if you had any advice for medical students or trainees to get involved in that experimental side of things? So actually, actually my interest in research starting as a student. So in second year, because here in Romania, you have, you have to do like a practical um three weeks or one month during the summer vacation. So you have the ability to choose where to go. So in my second year, I said, okay, um I mean, I can take a break from surgery and I went for um the genetics lab just because I was curious and I really liked the course um and the sessions during the semester. So I went there, they accepted me um as uh for my summer practice. Um And then uh the genetics labs was really next to the immunology lab. And because we did some uh techniques in the immunology lab, I've just started to talk with the people there networking. Um And then I ended up volunteering during the semester next year. Um And then I've written a small paper and went to a conference um for students for medical students and presented. And then actually the person that supervised me was the person that referred to me for the Mercury Fellowship. Cool. Yeah. Thank well, thank you for sharing that with us. Um This the question in the chat that says, um it may sound like a bit of a weird question. But have you tried a P A P pen or pat pen instead of the silicon ring to reduce the amount of solution required for each sample slash chamber? So, so the pack pen usually works if the slides are made out of glass. But because I prefer to use, um, plastic for better sell a difference because whenever you remove the insert, you can affect the cell sheet. Um, so because my slides were, um, uh, plastic and not class, a bad banded and forth, right? Ok. Cool. Um, if anyone has any other questions, please put them in the chat, we're happy to answer them. Um, and I just wanted to ask as well. Um, um, so often, uh, medical students, they can get involved in research through like they're interrelated degree at medical school. Um, and I was wondering if you are aware of any particular degrees that you could recommend to anyone at, in the UK that, um, that would allow them to go into the experimental side of plastic surgery. As far as I'm aware, I do know that, um, astrazeneca was taking, um, a sandwich student. So if you just, um, uh, apply, um, and then you can take a break from, from, uh, studying and just go as a center student and do research there. Okay. Cool. Cool. Well, um thank you for that. Um Is if there's, there's one question that's just popped up. Um So the question reads also these days, tumor micro environment have been the key interest in three D carcinoma. Do you observe any key differences in two D versus Freedy culture of melanocytes? Um Yes. So including including the monocultures, they do respond differently uh to, especially to two drug therapy also. Um And there's published research regarding these, you have um drugs that can work beautifully on two D culture system. Um You say yes, it's effective and everything. And whenever you go in in vivo or in a clinical trial, you don't get the same results. So that's why the three D cultures and because uh they better mimic the micro environment, um you also get results that are easier to translate in in vivo result in in vivo setups or in a clinical setup research. So yes, there are big differences between two D and three D culture system. And also now it's quite uh an interesting topic you also have uh because those who are static cultures, but now you also have dynamic cultures. So basically you can um circulate the media between multiple organ weight. Um And then again, you increase the complexity of, of your experiments and of your models and then your results are more reliable. Okay, thank you for that answer. Um If there any other questions in the chat, please throw them in. Um, otherwise we, um, we'll round off the event there. Um Thank you so much for giving us this talk. Um There's a really nice way to round off the, um, the other two talks which were more um, technical based. Um And so it was really, really interesting and thank you so much. We're really glad to have had you. Thank you. Thank you. Thank you. Thank you. So I don't think they're any more questions, so I think we'll end the event there. Thank you, everyone for joining us. Um There will be certificates available for people who have come and watched uh the big three talks and we'll distribute those over the course of the next few days up to a week. And we also have all of these talks on available on demand on the medal platform for a short while um if you like to review them. Um but otherwise we, we hope that you enjoyed um all the talks and we hope to see you at our next event um in the future. Okay. Thank you so much. Bye bye everyone. Bye bye bye.