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AMSA Careers Talk Series 1 (2023/2024)

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Summary

This on-demand teaching session is a unique opportunity to gain insight into the professional medical journey. Expert speakers include Dr. Hannah Huang, a consultant of Child and Adolescent Psychiatry, and Dr. Geff Chao who discusses his career path in radiology, specifically focusing on his subspecialty in musculoskeletal and neuroradiology. The session encourages discussion about the responsibilities, limitations, and prospective opportunities within these fields. It's part of a care talk series, sponsored by the MDU, a major medical defense organization in the UK. Both students and practitioners can benefit from these enriching talks, with students having free access to a wealth of study resources, indemnity for electives, and protection against fitness practice claims offered by the MDU.
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Description

The AMSA Careers Talk Series aims to brings together doctors from a range of various medical fields to shed light on their inspiring career stories. Here, they will share valuable insights about their day-to-day work, as well as the unique paths that led them to their careers, in order to give medical students a better idea about the pathways that lie beyond medical school. Moreover, they will include interactive Q&A sessions to give students an opportunity to discuss about their career options ahead.

In our first talk of the series, we are excited to announce our guest speakers as:

  • Dr Hannah Huang, Consultant Child and Adolescent Psychiatrist
  • Dr Geoff Chow, Consultant Radiologist

Learning objectives

1. Understand the broad role and responsibilities of a Radiologist in the healthcare field. 2. Gain insights on the specific subspecialties within Radiology, including musculoskeletal and neuroradiology, and their relevance in patient care. 3. Learn about the different pathways to enter into Radiology training and the competitiveness of the process. 4. Understand the importance of multidisciplinary meetings and the key role radiologists play in these settings. 5. Discuss the process of vetting and protocoling scans, emphasizing the goal to provide minimal harm and ensure the most efficient use of resources.
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Computer generated transcript

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

Hello, good evening everyone. So, er, hopefully you can all see and hear us now. Er, apologies for the late start. We've had a few technical issues. We've hopefully sorted them out now. Um Thank you for coming along to the care talk series. The first one we're running this year. Um Today we've been very fortunate to be joined by doctor uh Hannah Huang, who's a consultant, child and adolescent psychiatrist and doctor Geff Chao consults who will be giving er, two half an hour talks, er, about, you know, the careers, the, the career path, what their career involves and all the things leading up to it. So, um we've got a lot to all for you today. I hope you find it useful. Um This event has also kindly been sponsored by the MDU. Um the MDU as most of you probably already know by now is one of the major medical defense organizations in the UK and it offers p professional indemnity for clinical negligence claims and that's more for doctors in terms of students. Er, it's free for students to join, er, includes access to study resources, er, and indemnity, indemnity for electives and protection against fitness practice claims and everything. Uh like that. So there's lots to do for both students and practitioners and the QR code that they've asked us to put up there will take you a link to join the MDU. Um If, if you, if it's something you're interested in. Um, but I think that's everything we've got doctor Doctor Chao giving the first talk on radiology. So I'll, I'll hand over to him. Ok, thanks. Thanks Nixon. Um So hopefully everyone can see. I'm gonna try and share my screen now and thank you for the introduction. Um ok, so, ok, can I see the start of my talk there, Jeff? We can just see the um platform screen. So your slide. Let me, let me read you that. Sorry. No, I thought I had this down and I'm sorry, everyone. How's that? It's the, it's the same, same. OK. I'm sorry, everybody hold on unless I'm seeing something different to other people. Yeah, it's coming off the platform for me. Oh, there we go. Fantastic. Thanks. Ok, so yeah, so thanks Nick for the introduction. My name is Jeff. I am a radiologist at the Royal Free Hospital in North London. I also went to Imperial and was heavily involved in AM SA for the large majority of my time and really, really enjoyed it. So I hope you guys all are too. And yeah, just a short talk, really a bit of insight into what my job is like, and how I got there and how you might get there if you want to as well. So, um, so we'll get into this a little bit later, but I primarily do musculoskeletal and neuroradiology is a subspecialty within radiology. And I'll come to have a little discussion of what that involves and there obviously are lots of different options for what you can do. And that on top of that, I do do a bit of sort of general radiology, which again, I'll explain a bit later, but primarily I'm muscular in neuroradiology. Um ok, so I guess it's good just to discuss um broadly what does a radiologist do. So I imagine you're probably a little bit of a range of years. I know Nixon, you're saying your third is so just first clinical year. So your interaction, certainly my experience of radiology was very, very limited as a medical student. And that may have changed in the past 10 years, but 1015 years. But it's definitely I had very little exposure to what a radiologist is and what they do. And often a lot of radiology in terms of the interpretation images I saw through the eyes of my clinical seniors who were often very, very good at it, but it was always through their eyes in them discussing the scans as opposed to with a radiologist per se. So hopefully, I can give you a bit of an insight today into that. So we do a large part of our job is obviously diagnostic reporting. So that's through a range of modalities. So X ray MRI which you can see just partially on that image there an MRI head but also fluoroscopy which is basically dynamic live X ray imaging. So sort of high frame rate x-rays which you can see on the bottom screen is what we do a lot in our interventional procedures to allow dynamic assessment of contrast flow through whatever structure we're assessing. Um ultrasound is obviously a part of our job role as well. And then as I said, MRI and CT and then some groups of our colleagues will do functional imaging. So nuclear medicine imaging as well, where they're using specific radiopharmaceuticals, which are taken up by the body by varying amounts and using that we can see the function of various tissues. Um So that's obviously a large part of our work diagnostic reporting. So in front of a screen all of that time, but also a lot of us, not just interventional radiologists will do interventional procedures. So through using imaging for guidance. So for example, as I was saying, at the bottom, that's a neuroradiologist doing interventional neuroradiology using fluoroscopy, we can also use CT to guide our needles um into various locations. We can also use ultrasound. Um And we do all that for both diagnostic purposes and therapeutic purposes but and through a range of subspecialties and for varying reasons. So for example, endovascular work you can see here whether that's in the brain or in the in the peripheral vascular system or in the aorta, for example, for oncology. So for example, um hepatobiliary interventional radiologist will be able to deliver oncology treatment directly into tumors or embolize tumors to shrink them if they're very vascular. Um and then musculoskeletal, which is what I do where we can use ultrasound or fluoro or CT to guide in needles for aspirations for injections. So that's definitely a large part of what we do, even if you're not an interventional neurad, an interventional radiologist, I should say. And then other parts of our job, which you probably are probably a little bit less of that. We do a lot of. But actually, in terms of your interaction, if you end up being a clinical clinical doctor, your interaction with radiologist will be a lot of trying to get scans done. So vetting and protocol. And it's important just to just to emphasize that, you know, some, I think often we're seen as, especially when you're an F one and you're speaking to a radiologist trying to get a scan, we're seen as gatekeepers and people who are trying to stop all scans happening. But actually a large part of that process where you come and discuss scans is not so much about whether a scan will be done or not because actually the majority of the time these days the scans will just be done. It's more about trying to optimize the scans. So trying to get the right type of scan that will answer the question that you have. So that's a really large part of our job as well is trying to tailor the right type of test for your patient for the question that you have that you want answered. Um and also providing the least harm to the patient, whether that's radiation or, or you know, an aspiration or something that's more invasive, of course. And then another large part of our meeting, a large part of our job is taking or taking part in multidisciplinary meetings. So we are heavily involved in that. So a lot of MDT S will have a radiologist showing images, discussing images. So um for me myself, it's a large part of my work as well and it's quite a nice part of my work where you get to kind of really build a relationship with your clinicians and kind of really contribute. OK. So that's just broadly what a radiologist does. Um So I'll come to sort of my specific stuff a little bit later on. I thought I'd just quickly go into sort of how you get into training actually. And it's interesting just to look at how competitive radiology is. So last year, there were 3000 applicants for 350 places in England, Scotland and Wales, the ratio was about eight, nearly 9 to 1. But you can see that falls away, the ratio rapidly improves when it gets into usage where it becomes basically 2 to 1 you have 50% of getting in. And the reason for that I think is because a lot of people apply to radiology as a second choice maybe, or they want to do something else and it's like a backup, but it's certainly at the application level, much more competitive than it was for me. So we go. So I thought it would be interesting just to look at some of the data from, ah, this is 2023. So here we are radiology 8.77 to 1. And you can see it's at application level fairly competitive. Um, you know, I mean, there are obviously many others that are way more competitive. So cardiothoracic being one plastics, I think I'm not sure that's on there, neurosurgery, of course, being one ophthalmology is pretty competitive, but it's certainly up there at the application stage quite competitive. Um And if we go back, so I applied in 2015, so you can see it was nearly 4 to 1 and certainly you can see it's gradual trend is getting more and more popular in terms of applications. Um, but I think at interview level is once you get to interview, you've got a pretty good chance. So minimum requirements are medical degree and you either have completed or most people now probably apply in F two so are due to complete it. Um I think we get less, we got more f two entries than we used to. We used to get a lot more people who maybe have done core medical or core surgical training and then have changed over to radiology. Um Your applications then scored partly on your interview, partly on your portfolio evidence. And then this, this, this new part that for me when I entered in 2015 wasn't part of the application. But now is this Multispecialty recruitment assessment? So that's not exclusive to radiology, other, other specialties like GP do it as well. And just a quick kind of thought it would be interesting. I didn't do this but it was quite interesting looking at some of the questions and they're quite similar to what we had to do when we exited when we were actually applying for F one post. So a situational judgment type test and I think you have to hit a minimum score in order to progress to interview. But I thought it would be quite fun. I don't know, are people able to interact very much? Can they speak out on this Nixon? Or I just thought it would be interesting to see what people's thoughts were when I wanted to or type in the chat box. Maybe so I don't think they can speak but they can type in the chat. OK? But if I flick back to the chat will, it will get rid of my thing. It look. Oh, maybe if I read it out, you can just see if anyone responds because I thought it would be quite fun just to see what people think of this. Um ok, so you are an F two working on a medical ward. You're preparing for your consultant's ward round which takes place this afternoon. Andrew, another f two doctors working with you and he is also expected on the ward round. Andrew tells you that he must leave the hospital to attend a court hearing about a car parking fine, which you failed to pay, but he does not want the consultant to know about this. He asks you to tell the consultant, Doctor Stevens that the reason he cannot attend the warrant is because he is unwell. Ok, so you have to rank these most appropriate to least appropriate. So a advise Andrew to leave for the afternoon. B suggests Andrew informs doctor Stevens that he is unwell and so cannot attend the ward round. C explained to Andrew that you cannot cover for him on this occasion or d inform Doctor Stevens of Andrew's absence explaining that you do the reason why. Um ok. So does anybody want to hazard a guess? I mean, II was horrendous at the situation of judgment. Um I didn't get on it either. Any anyone shouting anything in the box? Oh, sorry, sorry, sorry, I need to do. Uh We've got Isabel saying a CD to B F from 1 to 4. Yeah, that sounds very a correct. A CDB. Yes. So yeah, first is I think the, the the reason is you, you should advise Andrew to request leave for the afternoon is kind of your basically not getting involved but telling him to kind of deal with it. Whereas I oversee which I think is a difficult one. The lower you are a little bit more obvious as to why. But anyway, I'm not here to teach him a situation of judgment as I'm not very good at it myself. But it's more, it's just interesting that this is, this is now part of the assessment, but films a small part about 20%. So portfolio is a big part and these are just um the categories that you have to kind of work towards. So it's worth, I think if you have an, it's very early days I think to, to, to kind of know what you want to do. But if you have any, anything that you may be interested in radiology, it is worth kind of starting to think about um you know, tailoring some of your, your portfolio towards it a little bit. So you start thinking about being involved in teaching or being involved in Amazon and things like that is always really good. Um You know, and if you get opportunities to do audits, things like that, it's always nice as well. And, you know, obviously things like academic achievements and things, those things will come later. But um yeah, I think if you can start to tail yourself towards it and I've left some links at the end of my talk. So some places you can go to get more information, but you basically get points for various things. So if you've done a very radiology, heavy radiology related audit that you can clearly demonstrate has changed practice, then you score maximum points. For example, if you have organized a teaching course, for example, you score maximum points, it's that sort of scale portfolio. Um OK. So training training itself is, so you do your F one F two, you get selected into radiology, you choose, you rank your schemes and according to your score, you'll be allocated your scheme in the country. Um and then you'll run through it. It's basic minimum of five years of training. So quite a short training program, but quite intense. So 1 to 3 is general core radiology. So you'll go through all the various subspecialties learning all the different modalities. And then uh once you've progressed through those levels, you're moved to ST four and five, which is more subspecialist training. So for me, that was muscular case of neuroradiology. Um I have got the time points in here, but at various time points you will do exams. So you'll do there's three parts to the exam. So there's a first part, you do an ST one in order to progress, you don't have to pass it to progress, but it's physics and anatomy. In ST three, ST 2 to 3, you do um a written exam which is just testing on all the subspecialties in a multiple choice type format. And then in your ST four, you do beginning of ST four, you do your final um F RCR exam um which is a part written. Um it, it's sort of a X ray reporting a test and um long cases that you have to go through and report basically and then a VR as well. So we're all done virtually now, but it's a vi vor reviewing cases with other consultants. And once you've pass that you can move into a sub suspect training. So there are obviously exams along the way and then once you've done that, that's you done for your exams for your training and then you just progress and you have to just hit your appraisals year by year and then you can complete CCT S completion certificate of completion of training. Um And then some people choose to do extra training at various points after this. So fellowships after your CCT is an option as well. OK. So core training and self specialty. So these are the various things you can do. You can say I picked TMI Neuro, a lot of people will pick one, but also lots of people pick pick two. Um And you know, it's not quite a strict divide. And when you come to meet radiologists in the future, when you're discussing cases, you might find that a thoracic radiologist also happens to report MRI prostate, for example. Um you know, it's not a complete clear cut of someone who does breast only does breast imaging. Um OK. OK. So my training, so I did my F one F two. So I was at Imperial, did my F one F two at Basildon in Essex. Then got into the rule free program for radiology that rotated through kind of more UCL type kind of linked hospitals. So rare, Whittington li the hospital in Stevenage at the time and also N HNN is Queen Square. So that's a National Hospital for Neurology and neurosurgery. And some people also go through Great Ormond Street as part of our training. And then I then did my ST four and five sub specialty in muscular fe was at the wall free. No, was at Queen Square. And then after ICC so II formally completed my training and then I went and did a fellowship at Queen Square as well. Um OK. So what does my job? So more personal to me actually entail. So um so this is actually quite a small part of my job, general radiology. So a large bulk of work in radiology is going to be acute on call body when I say general radiology, I mean body imaging. So chest, abdomen and pelvis and so almost all people have to do a little bit of this in their training and that's the trend that training and the curriculum is leaning towards now because it's such a area in need. Um, so, so I do, I do one morning of this a week and I also do it when I'm on call. So three or four weeks a year I have to be on call. There's a registrar who does the reporting takes the bleeps and I do, I basically check their scans the next day and I'm available for any queries. So just a quick, I mean, obviously there's a nice green arrow pointing to it here. But can anybody, does anybody want to hazard what? This is just, I mean, I think it's tricky if you haven't done very much but any anything in the box Nixon responses yet, no responses. So this is, this is an acute appendicitis case. So this this little Tullar thing is in the right ile far, so you can see the right Iliac crest here. Um So this tubular thing is actually the appendix. So we see it quite nicely on this axial view. It's again like a tubular blind ending structure and we see it on the coronal view here as well. And it's just, I mean, you wouldn't know necessarily if you haven't seen lots of appendices, but this is thickened, dilated, lots of inflammation around it. And this bright thing is an appendicolith at the origin of the appendix, which is why it's blocking it and giving you acute appendicitis. OK. So this is um so this is about, this is about half of what I do is M SK. So um so it's reporting X rays, CT MRI. Um I also do an ultrasound list. So um it's uh you know, so that's ultrasounding various joints, soft tissues, aspirating fluid if they need it for worrying of infection of a joint, injecting joints with steroids and local anesthetic for symptom improvement. Um So for example, here at the bottom, it's the is the actually would be what I would be doing is, you know, injecting someone's um subacromial bursa which is a bursa within the left shoulder. Um And this is the ultrasound image of what that would look like. So you can see the needle coming in here. This the g is the greater turo of the humerus and this white is the cortex of the bone. The s here, the structure that comes and attaches on the greatest turo is your supraspinatus tendon. And this our head is on the the bright structure. The white structure here is the bursa and the needle is in the bursa injecting steroid in. So we do that quite a lot, very common injection. We do um we also I also do fluoroscopy and we do arthrogram. So an arthrogram is basically injecting MRI gadolinium. So a dye into the hip joint called the shoulder joint. And the idea of that is to um allow something to be, allow the soft tissues in there to be seen better on MRI. And we can also use extra arcy to guide certain injections that are harder to see on ultrasound. Um So, so for my neuro side, it's again, about half of my week, I report CT and MRI, I also do lumbar punches. So when um clinicians have difficulty with patients who perhaps have abnormal alignment in the spine scoliosis or they have or they're very large, then basically we can use X ray to guide in the lumbar puncture needle, which is a little bit easier if we can see where the needle is going. Um Also do using CT guidance nerve root injections and passen joint injections of the spine. So, you know, this is not me, but in the CT scanner, you can see we've got the patient on their front and what they're doing, what we're doing is positioning a needle. It's basically doing this procedure here and we'll put in the needle tip in. You can't really see the nerve root, but it's just this shadow there. And what they've done is injected a bit of dye, which is encircling the nerve root. So they've confirmed they're in the right position. Um and then they're going to deliver a steroid here. So I do that kind of thing as well. Um So I thought it would be interesting. I mean, it's just to give you a breakdown of what I actually do on a day to day basis. So, um you know, I, so Mondays, I, you know, I'm doing nearer in the morning and then I have an MDT, as I was saying, we do a lot of MDT S so an MDT at the AF at lunch time on Monday, I do an ultrasound list. Tuesday. I do that little bit of general CT body, chest, abdomen and pelvis reporting. Um In the afternoon, I do my fluoroscopy injections and lumbar punches Wednesdays, busy day of three MDT S that day. So the HIV MDT rheumatology and the neurology one in the afternoon. Um Thursday, I only do a couple of hours but it's some neuro reporting and, and we'll come to sort of sorry, I'm, I'll be ok for time mixing for me to carry on, by the way, probably another 5, 10 minutes. Oh, yeah, that should be fine if you can. Um, so Friday, I was just going to say I'll come to kind of, I'll put in brackets from home because I think just in terms of pros and cons of work in radiology, it's quite nice to discuss where I do it. But Fridays, I'm set up at home to report so I can report from home. I do a meeting from home and then I report in the afternoon. So amongst all of that is lots of other things that are happening. So you know, we're in discussion with our radiographer colleagues who are obviously taking the X rays or the CT of the MRI trying to optimize images, help them with queries. Got registrars working alongside me who we will discuss cases and they'll have queries and I'm checking their scans and teaching. Clinical colleagues will come and discuss want opinions on scans. Other radiology colleagues will want opinions on scans and I'll do the same with them all through the day. We're doing informal teaching and more formally as well. And then I'm also the audit lead, they're all free. So the radiology audit lead. So, you know, I'm trying to help um do do audits to try and improve the quality of our work. Um I do a little bit of research. Um it doesn't form a lot of my week but I do a little bit. Um and then as part of all of us, consultants will have to do CPD and learning and self reflection. So CPD is continued professional development and where that can be reading papers, attending courses. RM is our radiology events and learning meeting. So you may have heard of it called a Discrepancy meeting. It's a really interesting meeting to attend. If you have access to it. If you're either on a radiology attachment or a taste a week, I would always try and go because it's where you bring all the um cases that perhaps other radiologists have missed or found difficult or have done really well and spotted something that was very subtle or made a very nice diagnosis. They all get brought to this meeting and we can share it with the department and learn from it. Um, so that's, that's basically my job and what I do on a day to day basis. Um, so, I mean, again, in the last couple of slides, really? So what's bad about radiology? Um, so it is, it is quite intense. I think you're intense in a different way. I think it's very, very, very challenging sort of in terms of how short the training is, what you're expected to be able to do and the responsibility you're given quite early on, you know, by your, by the end of first or beginning of second year, you're probably the left as the on call depending on your set up in your hospital. But for us, we were left as the kind of when you're overnight, you're the radiologist overnight giving opinions, patients going to surgery, et cetera, et cetera. So the learning curve was quite steep at various points and less patient interactions. So I think if you're someone who wants to interact with patients and have ownership of patients, which is the next point, then this maybe is an specialty for you because we have a little bit, um, we don't quite have that same, you know, day to day for most people, for most subspecialties, we don't have that day to day interaction. But I'll come, you know, for example, for myself, I do actually do quite a lot of interaction between ultrasound and fluoroscopy. But you can see it's only a small part of my job really. Um We are kind of sometimes I don't really think we are, but we have to kind of fight to not be, but we are seen sometimes as a service specialty. So in the sense that, you know, we're just providing, the clinician says we need an MRI. So we do an MRI. Um you know, and I think if you ask a radiologist, they'd always want to argue that we're not that and actually we're being referred to patient and we're discussing the case, but, you know, it's a bit, a bit of a maybe a bit of a contentious thing. Um And I think one downside is it is getting kind of crazy like workload is getting even though across the border and the NHS is going up in imaging wise, you know, imaging is being used more, more than it ever has been and it's only going to get used more in the future. So it's very, very busy. But all of these, you could turn into upside. So um I've put less patient interaction in a good bit because some people actually don't want to interact with patients at all. You know, being very busy can be a good thing because it gives you more opportunity. So what do I think is quite good about our job is it's very varied. Lots of interesting cases. It's really problem solving. So you're often having to really think and look into the medicine of it all. We're quite important. I think part of the diagnostic pathway helping in management decisions, whether that's just through your reports or particularly in MDT S when you're in there discussing with clinicians. Um, you know, I quite like the way I've set up my job is I'm sometimes sat there in the computer and kind of a bit more relaxed maybe. And other times I can be doing procedures on patients just speaking to patients, you know, using my hand, which is quite nice. Um In training, what's quite nice is it is very consultant led. So I think that is true is almost all the way through training. All your teaching is pretty much done by consultant, either one on one or in small groups, I would say now, especially as a consultant, work, life balance is quite good, you know, you can work from home and it's quite easy to do. So, most radiologists will now do a session or two or three at home. And as a consultant, usually the on calls aren't particularly arduous, partially because you can do them at home. Um And you know, if you're thinking ahead in terms of private work or not even necessarily private work, but additional income on top of NHS, it's quite easy access just because of how much there is to do that you can do at home. And I'm thinking more specifically about teleradiology where a lot of people report for external companies for NHS patients. So they are just a summary of some of the good things about radiology. Um What else? So if you're interested, there's a couple of links here which I'm happy to send out the presentation just about how to get to radiology, what it's about. Um, so, but if you want to get in contact, that's my email address. Maybe depending on what stage of training you're at and if you want to do a taste a week, you just let me know and we have people who set it up for us. So, um yeah, that's it. Any questions I guess we'll have later, right? Nixon? Yeah, that's right. We've got the K A at the end. Ok, I will. Sorry, Hannah, I've eaten into your time. Hanmer. Sorry, don't worry, Jeff. Um, shall I go ahead Nixon? Er, yes, please when you're ready, Han? Cool. Um, well, thanks Jeff for um a really interesting, really interesting talk. Um It's nice to actually um, learn about what you do after knowing you for so many years. Um, so Jeff and I, er, were actually imperial, er, together. I think I was in the year, er, below Jeff's stage. It's nice to see you and it's nice to see um, everyone attending today. Um, apologies for the technical issues earlier from my end. Um hence the late er start, hopefully things are working now. So I'm going to try and share my screen. Ok. Has that worked? And you can still see and hear me? That looks perfect. Great. Ok, so um my name is Hannah Hwang. Um uh I am a consultant, child and adolescent psychiatrist. Um like I've already mentioned, I um I did my medical degree at Imperial, um, and I was um, core of a MSA think like 2011 or 2012 a long time ago. Um, but yeah, II also really enjoyed, um, Imperial and also um, University in London. Um, and uh I am now a consultant psychiatrist at, er, South London and Maudsley NHS Foundation Trust. I currently work in a, uh community team in Lambeth. So, um, the things I'm going to cover today very similar to, um, Jeff's talk. Er, obviously I'm going to, um, speak about, uh, my career, um, as a psychiatrist and also, um, what, um, a psychiatrist does, er, the training pathway, why you should choose psychiatry and what you can do now, er, to stop preparing if you are interested. So, um, first of all, um, what does a psychiatrist do? Um, so, uh, hopefully you guys have um, a bit of an idea of what a psychiatrist does but I, um, I understand that some of you may not have done, um, a psychiatry block yet or mental health block yet. Um, but in essence, uh, we are experts in mental health, uh, specializing in the diagnosis and treatment of uh, mental illnesses. Um, and uh, I guess one of the, um, ways that, uh, perhaps a psychiatrist is different to say, like a psychologist is that, um, we have a really, uh, kind of good understanding and it's kind of part of our job um, to think about how physical and mental health interact. Um and er, a lot of you might know that, you know, like the mind body, er, link is um becoming ever more important, especially um since uh COVID. Um and so, um kind of the role of the psychiatrist um is changing quite a lot um in recent years as well because of that, um we work in a multidisciplinary team, er, providing holistic care for patients and their families. Um and the multidisciplinary team can be uh can consist of um nurses, um psychologists, therapists, er, practitioners, OT S. Um So it's a real, it's a real team, er, effort um to really kind of understand uh patients in a holistic way. Um we er provide urgent care for acute mental illness uh especially when we're on call. Um And so, uh when you're on call, um you typically would uh be covering uh the acute uh mental health units but also A&E S um and um you may encounter, you will encounter um pe people who are um acutely unwell acutely psychotic, um, acutely suicidal. Um, and you'll need to kind of make uh decisions, er, kind of there. And then, and that could, er, involve the use of the Mental Health Act or the Mental Capacity Act. Um, and so you really, um, there's a lot, um, a lot of overlap as well with um, kind of, er, legal, er, the legal frameworks, er, in order to section or detain a patient. Um, and then you also see kind of the more chronic uh mental illness which may take a la longer, a bit longer to um manage and treat um and assess those patients as well. Um We are experts in prescribing psychotropic er, medication, er, which can include antidepressants, anti psychotics, such and stimulant medication just to name a few. Um and uh you also have the opportunity to train in and provide psychological treatment including uh cognitive behavioral therapy. CBT um psychodynamic psychoanalysis, um psychotherapy and um family therapy as well as a host of other uh modalities. Um And um there are also some opportunities to conduct procedures. Um the main one being um ect T um as a child psychiatrist, that's not something that we do. But um if you work it uh with adults or older adults, um CT can be um a good therapy for uh kind of treatment resistant depression or uh schizophrenia. So, um this slide um is really just to show you the kind of breadth of um conditions um that um we see um as psychiatrists, um we use the um ICD classification. Uh We're actually moved on to ICD 11. So I need to update uh this slide but um this gives you an idea of kind of the, the sort of um things that we see. Uh So from kind of organic um er disorders like dementia delirium to schizophrenia and psychosis and the different types of schizophrenia, mood disorders, obviously, um mania and depression, anxiety and panic O CD disorders, uh personality disorders, um, and also um eating disorders and uh neurodevelopmental disorders. Um, things I haven't listed include kind of things like, um, I don't think I've listed it here unless I can't see it. Um, addiction, er, gaming disorders, which I think, um, have made it into ICD 11 as well, which are, is becoming um, er, more and more common and of course, um, patients aren't, er, always simple. Uh, in fact, they are most likely going to be, er, complex and so they, you, you know, you have an overlapping um, conditions or traits um that might affect, er, patients on an, in, like, in, as an individual. Um, and so part of your job as a psychiatrist is to think, um, are there other comorbid conditions here? How does that all feed in, into what we call their formulation? Uh, what are the kind of precipitating, er, er, perpetuating protective factors here? Um, that, um, help shape this person um, and um, really kind of thinking about all the, um everything that's going on in their lives that, um has, um, that, that causes them to kind of present in a particular way. Um So, you know, obviously, like I said, every patient is um unique. Um, and, um, re remembering that when you, when you assess patients, um, so becoming a psychiatrist. So, um, I hope you can see this. I um, uh, I hope it's not too small. Um But obviously um medical school where you guys are um at, at the moment, um I would say that at this stage, maybe um using I II, remember when I was at Imperial, um we had like a special interest module um or a medical elective at the end of um uh your um degree. Um Those are kind of good opportunities to um obtain further psychiatry um experience. I think when I was at Imperial, I did a forensic psychiatry um special interest module. Um And uh I had the opportunity then to go to Broadmoor Hospital, which was um really um interesting and a really um exciting opportunity. So make, make the most of what your medical school can um offer. Um And then er foundation training uh uh obviously two years F one F two. Um And um during my foundation training, um I did II specifically chose um a set of rotations that would allow me to do um one psychiatry rotation. And I think um a lot of um training programs, foundation training programs now um require you to do either at least psychiatry or GP. Um So, um again, if you know that you're interested, make sure that you pick um a rotation that allows you to get the experience um that is relevant. Um And also um as, as an F one F two, you can organize a taste a week um if um if you can. Um so I did my um f one at Adam Brooks in Cambridge and then my F two in Bedford Hospital. And so, whilst I was at Adam Brooks, I did psychiatry rotation and then organized a um liaison psychiatry taste week. Um and then also try to attend co courses and conferences, er, related to psychiatry if, if you can. Um and that's relevant also. Um now if you know that you're interested, um you then um apply er for core training um and for psychiatry that's three years. Um It's a national application. Um and the um it requires um exactly what Jeff was talking about earlier, the um Multispecialty recruitment assessment. Um So I think now the application, it used to involve an interview as well, but now it's solely based er on the multispec er, the M SRA. Um And so, um yeah, that's becoming more and more er popular as a um assessment tool for um multiple specialties. Um So, um that's an important one to kind of get your head around. Um, and thank you, Geoff for um, demonstrating, er, an example question. Um, so yeah, the whole, um, the whole assessment is based on that and then you'll, um, er, there's a national ranking, um, and within call training you will have rotations in various different specialties which will, I'll go into, um, in a bit. Uh, so you'll do, um, adult a year of adults, uh, some child, adolescent, perhaps some learning disabilities or forensics or older adults. Um, and then you'll have opportunities to train in um psychotherapy competencies. So, um, do having a CBT case, for example, having a psychodynamic psychotherapy case um, and really kind of um, getting, er, experience in delivering, er, those therapies. There are, er, three, roco of psychiatry exams that you need to take which most people take um, during those three years. Er, there are two written papers and one practical um exam which we call the cask and then you obtain, er, RC psych membership. Um, and then uh you apply for higher training, so, registrar training, uh which uh is 3 to 4 years, again, national application. Um, it involves a self assessment, uh which is portfolio based, um, again, similarly to how Jeff described. So, um, and you get, you get um, points for audits, teaching research, that kind of thing. Um, and there is an interview at that stage as well. Um, the, um, the higher training, er, that you choose, um, is based on what subs subspecialty of psychiatry. Um you, er, you want to subspecialise in um and at the end of er that training, you um achieve CCT and then you can apply for a consultant uh post. Um And within a consultant, er, job you have, you can have opportunity for management uh and teaching, but that also applies for um the, the whole of your training. Uh really, so that's uh the training pathway in a nutshell. Um And um so when you're in your core training, um you have an opportunity to get exper get experience of um these specialties and then you can um choose to subspecialise um in higher training, you can. So there are, you know, um different um specialties based on age uh but also based on need. Uh So there's obviously a general adult which is working age, er, people. Um you can, er, work in older adults in which case that you may be um more specialized in um dementia or physical health, child and adolescent, er, cam um specialty, which is what I'm, I work with Children and young people under the age of 18. Um, a lot of the work that I do both neurodevelopmental disorders, assessing and treating autism and AD HD. Um and you get the opportunity to work alongside schools and social services and other agencies um and o and other medical specialties um such as pediatrics. Um, forensic psychiatry involves um er, treating patient patients with, er, mental disorders who have been or have the potential to be violent. Um, and, um, you, um, can work in, um, prisons, secure hospitals, er, communities. It's quite a lot of legal work and court reports and things like that. Um, but very, very, very interesting, uh, specialty. Um, there's also intellectual disability, um, working, uh, with people with learning disabilities, um, who may, for example, be non verbal, not, not able to express their needs um as um easily um who perhaps have um behavioral problems. Um And so um need specific help with their mental health. And there's also medical psychotherapy where um you a psychotherapy is a much more um dominant part of your job. Um and um you were able to kind of specifically train uh in, in um psychotherapy, there are also opportunities to um er do two subspecialties. Um So you become dual trained, the most popular. One is general adult and old age. In which case, then your higher training increases from three years to four years. Um There are also opportunities for, for example, CAM S and um intellectual disability as a, as a dual uh training program. Um There is also um in more, more recent years. Um this has become more popular um run through C A MHS and learning disabilities um training in which you will apply um after F two straight into CAM S or learning disabilities and you'll, you'll run through the six years. And um there are um as with any specialty opportunities for academic er, clinical fellowships and then um there are other specialties where you, so you wouldn't necessarily um specialize uh in these, but you can get further accreditation as part of your subspecialty uh specialty training um in er eating disorders, addictions, liaison, neuropsychiatry, and perinatal. Um I think most of these are um applicable to all of the subspecialties, eating disorders. Certainly we see a lot in CS and a lot in adults addictions may be less. So and perinatal obviously is um uh for women of childbearing age. Um but there are opportunities within the subspecialties to um get further accreditation by doing a full year of experience within your training um for that. Um So why do I think you should choose psychiatry? Um So, um if you enjoy patient interaction, um then this is a real opportunity for you to really get to know your patients and also um really make a difference um and changing their lives the better. Um you know, it's, it is a very satisfying job. Um people may come to you um at a really, really dark place um And for them to be able to engage with you um and be open uh uh with, with you and be for you to be able to change their lives is um and to see them get better is um a real, real privilege. Um So, um I think, yeah, that's uh one of the um reasons why you should choose psychiatry. Um Also, it draws on a combination of scientific knowledge, medical expertise and interpersonal skills. Um And I've, I've always said that um obviously psychiatry is a branch of medicine. Um But I often see psychiatry more, more like an art than a science. Um It is quite a nuanced um specialty but it really, um you can really um kind of uh yeah, break, break away from, from the science. Um, and, um, kind of, yeah, get, really, get to know, get to know your patients. Um, you can work in a range of settings from hospitals to the community to prisons. Um, like I've, um, said, um, to hospices. Um, so, yeah, um, I think mental health is something, um, that is becoming, um, more of a hot topic regardless of what, um, specialty you're in. Um, and so, um, I think, um, yeah, it's, it's gonna be prominent everywhere. Um, the, so, um, similarly to what Geff was saying, actually I think psychiatry is one of those, er, specialties where the transition to hybrid working has worked really well. Um, and certainly at the moment, um, I work from home two days a week, er, with online appointments and online meetings. Um, and that works really well and naturally the evidence for online appointments, online sessions, um, using telepsychiatry, um, is, um, well, it's evolving but it's, it's, it's, um, it has a good, er, evidence, er, for it. Um And so yes, uh that allows me to be able to work flexibly, which really works for me um as well as having the face to face um clinic time, er, for the, for the patients that need it, that it goes without saying that um you um encounter new and interesting challenges every day. Um And um you work, you really work in a multidisciplinary team um and er, you're able to um draw knowledge from other um specialties uh but other professions as well. Um And the training offers flexibility um in career progression. Um And you can really kind of shape your career pathway around uh what you're interested in um mental health research is, I think some of the most exciting, er, research and um, fast growing, er, research there is. Um, and there's still a lot of unknowns, er, about how the brain works. Um, and the therapies that we're using. Um, and so I think um that's also something really, really exciting. Um So, um what's it like being uh a trainee psychiatrist? Um So, um it's not been that long since I was a, I was a trainee. Um And um I think one of the really good things about um choosing psychiatry is that typically and I think this is relevant um throughout the country. Um certainly where I trained, um, you do get a decent work life balance. Um, you're, you're not on call, you do have to be on call. Um, but it's not that often. Um, and as a consultant, um, I'm on call, um, maybe two times in six months or something like that. Um, and a lot of the time you can do that from home, um, the weekly clinical supervision um, is mandatory, er, for, er, trainees. And so, so you will have, um, a set hour a week, uh, to, um, discuss cases, um, and, and get direct clinical supervision from your supervisor. You also have um supervision for psychotherapy cases um that you're doing. Um, certainly when I was training, um we had a full day teaching a week. So every Wednesday, uh we would um uh we would have lectures um about various topics um in psychiatry and as a specialist trainee, you also have a special interest day where you can, um, so it's a nonclinical day where um you can choose uh what you can choose what you want to do with it. Really, you can do research, you could do teaching. Um, you could do um, management stuff. Um, that's one day a week. Um as a, as a higher trainee, um, wellbeing and pastoral care is um, really important. Um, obviously, um, one of the downsides of um being um working in mental health is that you do see some hard hitting things, um, a lot of the time. Um and so being able to um debrief and having the space to debrief with um your colleagues um and having reflective practice is really important. Um And you have the ability to kind of build that into um your schedule. Um And there are also out of program opportunities. Um Again, teaching and research. Um You can do um post graduate studies, the PG Cer MS es, do a phd. So for me personally, um I was very interested in family therapy. And so um I did a postgraduate certificate, um a part time uh certificate in, in family therapy in the last two years. Um And if I wanted to take that further, I could um do the masters and um kind of become uh a family uh therapist. So lots of opportunities to do other things. Um And um I've put less than full time training in because I think that was one of the perks um when I did this um talk last, but II think hee have rolled that out um to um other specialties as well, but doing less than full time training is now um much easier to do um uh than before. Um So here are just some links um that you might find helpful and I'm happy to share these slides um with you all. Um The Royal College of Psychiatrists have some really um good resources. Um And um you can see the, the conferences and courses um that you can um register for and go on um conferences and courses are always a great way of networking. Um and um er, making, er, yeah, making connections. Um II met someone as in when I was an F one at a conference who then went on to become my mentor and um you know, that kind of um support and having that person is really, really um can be really helpful. Um um Hee will outline kind of the person's specifications for applications and things like that um And things that you can do now um join a psychiatrist society um at your medical school. Um because I'm at the Maudsley. Um I know that Kings have specific um societies um that you can er and mental schemes that you can join. Um So things like the Psychiatry summer school, I think is something that happens. So again, this link is outdated. Um but yeah, search for the um IO PP summer school 2023. Um and also the um Psychiatry Early Exposure program or PEEP program is something that I think um King students can sign up for um in order to get kind of bud up with the psychiatrist um and be able to kind of do some shadowing and things like that, but all these things are really um important um and helpful um and look great on your CV um in time for um applications. Um that's the end of my um talk. So I'm just gonna stop sharing. Um I hope we're OK for time. Cool. So uh Thanks so much, Hannah and, and Jeff. Um Those are two very interesting and useful talks about two very important fields in today's healthcare. Um We, we've set aside so at some time, we've got till 830 for some Q and A s. So, um, for, for any, for, for the attendance, feel free to write any of the questions in the chat. And hopefully Han and Jeff, you can see the questions as they come up. I've actually got a question first if that's ok if I could, uh, steal president privileges. Um, I think it's mainly for Jeff, um, but might apply to Hannah too. Um, so obviously a I has become really kind of apparent and has been growing in the last couple of years. So I was just wondering whether it's something you've seen in your practice, maybe, especially radiology. And is it something you're kind of scared of that might take over in that suit? It's a really hot topic at the moment. Thank you, Leo. Very quickly, Hannah. A really good talk, by the way. Thank you. Interesting to hear. You're right. I don't really know that much about even though I know you're a psycho, I don't know how much it's, it's quite cool to hear. Yeah, Leo. So a massive topic in radiology. It has been, even since when I started like eight years ago. But, um, like it, it, I don't, we don't really, it really depends on the sub specialty. So it does have its uses. I mean, I'm trying to sort of take away my personal views on it as well as in kind of remove my personal views from it a little somewhat. And just in terms of what is actually in uses, it does have certain applications, like for example, in lung nodule detection, it's very good in mammography, it's starting to get used a little bit. So maybe in the kind of pure pattern recognition aspects of our work, but, you know, it's certainly not widely utilized. There's lots of things out there that have been created the software, the algorithms that allow you to do it. So even for me with neuro, we have algorithms now. So there's a I now that, you know, kind of deep learning A I which is able to detect on acute A&E patients with head injuries, bleeds, infarcts with actually pretty good accuracy, um very, very, very high sensitivity and speciality. Um But uh in terms of their true adoption into clinical care, not so, you know, maybe that's a little bit of resistance from us. A kind of not just radiologists, sorry, but humans, I mean, like radiologists and clinicians trusting it fully. And also on top of that, it's the kind of legal set up behind it. So who's taking responsibility for any errors that do occur? Um So, but in certain fields like one big one is lung nodule detection. It is very useful in being utilized? Am I am I or many of us actually worried about it. I wouldn't say so because I think there's definitely recognition that pattern recognition is one part of our job. And actually a lot of it is sort of tying it together with the clinical, you know, forming that part of the jigsaw in terms of diagnosis. Um and not just kind of picking out an abnormality here and an abnormality there, it's actually putting it all together with the condition. So, and also the interventional side as well. So I think that's not gonna be replaced any time soon. That's great. Thank you. And I think it just to say for psychiatry, um I think we're a long way off. Um So if you want a job for life, I would, I would say that's a, that's a plus um to, to go into psychiatry, but because it's so personal and nuanced, um I mean, that's not to say that A I um will won't become more intelligent than humans in which case then? Yes, maybe they'll be able to detect emotions and things like that. But I think that that is still we're probably going will be the last medical specialty to um be able to adopt that. Very interesting. Thank you. I think we have a question from uh is there what other specialties were you considering? And when did you both know that you wanted to do radiology and psychiatry respectively over the other ones go on Hannah, you can go if you want. Um, so for me, um, I also applied for GP when I applied for core training. Um, that's, er, because, er, we had to take the same test, the M sra so just thought, why not as a backup. Um, and, um, when did I know I wanted to do this over? II, I've always been interested in psychiatry. Um, and like I said, um at medical school I did II chose to do some um specific modules in psychiatry, but I never really thought that I wanted to do it as a career. I thought it was um I thought it was going to be, you know, um emotionally taxing um and stressful. Um but then I actually did a placement in so like I think the F one placement is really important um because actually getting experience in working in that um specialty um really um opened my eyes. Um And then that's when I decided, ok, like this, this is what I want to do. Um And um hence why then I, I've kind of decided to tailor my cd more, more towards psychiatry. But I think the interest for me has always, always been there. I think the realities of it only kicked in kind of around F one don't know about you. Ah Yeah. Yeah. Similar for me, I decided to do it in F one. I think I was on a urology attachment. At the time, we had a lot of interaction with an interventional radiologist doing nephrostomy for the kidneys. And we used to go to them and discuss strains all the time. And it just, I actually wanted to do interventional radiology initially. It just seemed really cool and I didn't really, so that was my second attachment in F one. I think it was so, and I just started kind of working towards that. I didn't, I didn't really apply to anything else, I think just because I wasn't really sure whether I had no idea I wanted to do initially like GP um medical, medical specialty, surgical specialty as a medical student. I wanted to do psychiatry actually. Um but then, um yeah, so then it was only really an F one I decided about I'll do radiology and then just kind of went for it and then gradually moved from wanting to do interventional radiology to, to do a mix of stuff. That's great. Thank you. Um Isabel's asking as a radiology trainee, how much responsibility do you have in terms of reporting? And how did you deal with the steep learning curve in training that you mentioned? Um Yeah, so it does depend a bit on what program you're in. So for my program specifically, um you don't take on very much for the first, maybe two thirds of ST one you don't do very much you're very protected. And actually people feel a bit like kind of become a student. Again, you just kind of sit there kind of learning and you go from being a relatively independent F two to doing that and it's a bit of a change. Um But then after usually about two thirds into the year, you'll do an on call exam and you'll be tested on your X ray reporting your ct acute reporting. And if you pass that, then you basically get allowed to release your X ray reports independently and you start to be allowed to do your own ultrasound list independently. And then for me, it was only beginning of ST two, about three months into my second year that you were the on call kind of radiologist overnight. And then you're releasing your CT report. So whether it's head, neck, chest, abdomen pelvis, you release those as like a provisional report. Um but you know, the clinicians will act upon that. So there's responsibility so they'll discharge patients, treat patients, but your report will technically be checked by a consultant within 24 hours and you know, with other things, it takes longer. So, um you know, I was doing aspirations and drains independently by second year, but then I wouldn't release an MRI report until I was a consultant. So, you know, it's a bit, it really depends on what you're doing. But like MRI I II wouldn't finalize when I say finalize. I mean, no one else looks at my report. I wouldn't do that until I was a consultant. But with CTO, I did that much earlier as a trainee. So it just depends a bit. How do I do with the learning curve? I don't know. I think you just go through kind of, um, I guess you just end up kind of, you know, lots of work. You have to do a lot of reading and, um, uh, I guess, yeah, lots of reading and just kind of like you do a lot of practice and speaking to your seniors and just, I guess just being conscientious to it, like we all would be, I mean, in terms of the stress of it, that's quite hard. I think it can be quite stressful but training in any specialty, I'm sure psychiatry or any other is very stressful at times. So then you're just kind of leaning on family, friends support network. But I found certain parts of training very, very difficult and very stressful, but I don't think that's exclusive to radiology. Perfect. Thank you. And this one's for Hannah Maria is asking what are the things that you like least about specializing in psychiatry? Yeah. Um, yeah, I didn't really, um, touch on that too much, um, in my post, obviously. II want you guys to choose psychiatry. Um, but yeah, I guess the realities of specializing in, in, um, psychiatry or that, um, you are, um, interacting with, um, sometimes quite distressed, uh, patients, um, on a day to day basis and, um, it's, it can be hard sometimes to kind of separate that out from your own life. Um, and, um, I think, um, you know, that's, I think that's one of the, the main things that some people struggle with, um, and some people, if they can't hack it and they can't continue then that's, that can be a real barrier. Um, on the flip, on the flip side. Um, it's sometimes because you're so exposed to some er those things um it can become normalized for you. And so I think um it's kind of finding that balance um where it's not like, oh OK. Yes, I'm seeing another suicidal person and it doesn't affect me anymore and like, you know, being still remaining human and still being able to remain connected um to every patient that you see rather than it just being like, oh, ok. Um you know, another, another suicidal er patient and this is what we're going to do. Um And so, yeah, I think um finding, finding that balance of letting it not affect you too much personally, but then still kind of being able to show empathy and showing that you are still human and you're there to support them um is uh can be, can be hard. Um like, like Jeff said, making sure that you have um the right support um family colleagues, um things that um help you destress is, is super important and, and making the most of, um, those, um, kind of debrief and reflective, er, sessions as well. I think one of the other things as well is that a lot of the time in psychiatry, um, or some of the time, um, most people are quite grateful but there are some patients who obviously who have no insight who, um, perhaps will see you as a bit of a enemy. You know, someone who's forcing them to become sectioned or detained. And because they don't, they don't realize that they're psychotic or they don't realize that they're manic. Um and so kind of helping to educate those patients. Um But also realizing that you are making a difference for them, you're making their lives better even though sometimes you don't get that gratitude um back um can, can sometimes also um be tricky, but I think that's um part of the job. Um and something that you have to, to do uh to mitigate kind of risk and things like that. So, yeah, I was just going to say my memory of psychiatry. I just remember thinking when you just mentioned how hard it is not to relate. I remember loving, really enjoying it. And God, I struggled with not pulling every theory into my own life and into my own life. And that was, I found that really difficult I have interest. I mean, I still find it really interesting. There's a book, I don't know if you, I just have to Google it again. Who authored it. But it's called the Devil, you know, encounters it. A psychiatry. But it's really, really interesting. I haven't actually read it, but yes, I've heard of it by Gwn and Ene Horn. If anyone's interested in psychiatry, I think, I mean, I've read about halfway through it but it's really, really interesting. That, that's great. Thank you so much. Both, um, question from Chris, uh, for both of you. Uh What is the scope for private practice or doing other things like running your own? C go on Jeff, you can take this one back. Um I think that there is quite good scope. So um not necessarily private practice if you wanted to do that only, but in terms of additional income, like I was saying, teleradiology is a very easily accessible way of earning additional income on top of your NHS work because as I said, you can do it from home. There's lots and lots of work to do. It's basically backlog work for the NHS gets sold to private companies who then employ radiologists to work for them and they pay per scan most of the time. So it's not a huge amount. But if you're doing volume reporting, then it will kind of, it's not per scanner is lucrative compared to doing true private reporting. In terms of private practice. There is scope. But you know, all things private practice, if you can't just one day be like, oh I want to do it and you just do it like you need to have a referral. So for us, we need a referral base. So you need a clinician to refer a patient to you. So you have to have built a relationship with them either on an individual basis or the other option for radiologists is you join a consortium. So a lot of say, let's pick the Wellington Hospital in North London. There's a consortium group of 2030 radiologists who will work together. So you've got to be allowed into that consortium. So you have to kind of, so there is scope for that, but it's not a case of like click your fingers. I'm going to go start doing private practice. It doesn't quite work like that. And I think especially in radiology, you're a little bit more reliant on the referral from a clinician. Um So, yeah, there is scope for prior practice, but it's not that easy, but additional earning relatively easy. Thanks, Jeff. Um And in psychiatry, um there is definitely scope uh for private practice. Um I think once you've become a consultant, um It's definitely something um that I've been thinking about although I'm currently uh full time in the NHS. Um But um with um kind of the ever increasing workload and waiting lists, especially in child and adolescent psychiatry, things like um autism assessments, there's almost like a two year wait uh for autism assessments, ad HD assessments again, um, really long waiting lists and a lot of people are turning, uh, to private health care in order to get those done and they can be quite lucrative per assessment. Um, I think the thing that we're struggling in the, in our specialty at the moment is kind of the over diagnosing of ADHD. And you may have heard, may have seen in the news recently. Um, so I think at the moment, um, there's no kind of, um, like, um, uh, yeah, I think they're trying basically, um, there's a bit of skepticism about private, um, assessments and things like that. So, if a clinician has also does a bit of NHS work as well as private work that will make their report more credible. Um, I don't know how things are gonna, um, change in the future. Um, but there's definitely, um, there's definitely scope, uh, especially in child and adolescent psychiatry where perhaps a parent is able to, um, er, uh, payer for sessions rather than it. For example, if you're working with adults, um, who don't have insight, then they're, they're probably not gonna wanna pay you, um, to treat them for something and they don't think they have. Um, so I think, um, yes, definitely scope in specific things, um, running your own clinic. Um, again, I'm not, I'm not, I'm not too sure there are definitely clinics that you can join. Um, er, that, um, and then I suppose then if you build up your own client base then, um, then that's a possibility. Uh, but I don't know too much about that. Perfect. Thank you. And Sarah is asking what is something you wish you knew before choosing your speciality. And if you have something that comes to mind, I'm thinking about it and II can't, nothing's come to mind yet. Something I wish I did before choosing. Um, I, well, I guess this is just my own, um, naivety, I guess. Um, I guess I didn't, I didn't quite realize um how much um psychiatry would be kind of therapy based. Um And that, um that's part of your training. So to have to do kind of CBT and psycho psychoanalysis and things like that. That's maybe something that I didn't quite prepare for it ca obviously, um uh having done the training and stuff, it, it's um uh really, really good skill um and experience um to have. Um, but maybe at the time I didn't, I didn't quite realize how much of it would be. Um, that obviously you guys have attended this talk. So now, now, you know. Um, but um, yeah, other than that, um, yeah, I don't know. I mean, I was going to say, um, yeah, I guess I came in as I think I mentioned and I wanted to do interventional radiology. I was quite fixated on that initially and I think that I guess maybe I just didn't have as much appreciation for diagnostic radiologist, radiology, how much of it, how important it was, how it could also be enjoyable and rewarding. I mean, not that I had no idea, but I think I kind of um I could have been more open minded towards it all and I think that just kind of influenced my training at the start, not that it would have changed what I chose, but I think that probably, yeah, that's great. Thank you. Um Is the pathway for interventional radiology is the pathway for interventional radiology difficult slash more competitive to get into compared to the traditional diagnostic radiology pathway. Not really. Um you know, I think so traditionally and I think the majority of the curriculum does change every now and again. So by the way of some of the entrance requirements and that things will evolve over time, of course, and I say that because even the curriculum within really oddly evolves and how they set up training for interventional, for example, and diagnostic. But it's not like you apply to get into it specifically. I think that's the question, isn't it the path? Yeah, you basically apply to radiology. And then, so this is something again, I didn't really know until I kind of got into it a bit more when I first wanted to do it was you just apply for radiology and then you get into radiology and once you're in, you basically do your general training and you only declare what you want to do later down the line, like three years down the line you do in London, we do a matching process. You apply to match to a program within Radiology again, within the London various programs to choose what you want to do. One of which could be interventional radiology. So that's the third year. There is the newest curriculum, like a slight change where you technically can apply and join to be an interventional trainee right from the start all the way through. But say, for example, the one trainee who's come to do it at the all free for us isn't being treated any differently. So, and I don't think his application was any more competitive or different. He just got in and he's now being treated exactly the same. So he won't just go in and just start doing procedures because there is a big recognition that in order to be an influential radiologist, you need to be a very good diagnostic radiologist, first of all. So you have to have that skill set. So, and the pathway itself isn't, I mean, so I should have said it's slightly longer. So um interventional radiology, if you choose that as your, as your subs specialty is three years rather than two years. So you'll do ST six as standard without a fellowship, whereas you can do M SK and finish at fifth year if you wanted. Although many people go on to do a fellowship So intervention is, I guess you could say it's more difficult because it's slightly longer, but I wouldn't say it. Other subjects have their difficulties too great. Thank you. I think that's the last question in the chat. But one final question for both of you from me, um Kind of maybe more imperial specific, II know at kings it's an option to intercalate but is it important to intercalate in something that's kind of specific to these specialities? I know imperial still doesn't offer something radiology specific or medical physics or is it kind of, does it not really matter what you do? And along with that, is it still important to try and get as many publications as possible? Go on, honey, you go fast. Um So um there wasn't a psychiatry um indicated BSE option. Um I think King's did offer and still does offer something in psychology, I believe. Um, but um, so I know I didn't do anything uh related. In fact, back then I didn't know that I want to do, wanted to do psychiatry. Um, so II actually did management, I think Jeff, you did management as well. Yeah. Yeah. Yeah. Um, and actually, um, really enjoyed, er, management and it was a, um, a kind of AAA break from, from clinical stuff for a year and I think actually, um, picking something that you're interested in, um, now is like way more important than kind of planning for the planning for the future. Um, and certainly, er, with my management degree, um, it's really helped me, um, and there are loads of transferrable skills that you, um, you, er, pick up from, from doing something like that. And, um, it's actually something that I still talk about in, in interviews. Um, it's basically cos there's, um, any specialty that you go in has a bit of management. So it is now a plug for management but it's not. But, um, basically, yeah, there are loads of transferrable skills and so I certainly still use a lot of the, um, things I learned in my BSE in my, um, job now. Um, and I think that's, um, the same, er, for any, um, BSE, er, or specialty that you choose. Yeah. Yeah. II completely agree with you. I think, do something that you're interested in now. I don't think, I guess if, you know, you're thinking quite far down the line to go, I'll do Neurosciences because I want to be a neuroradiologist that's quite specific within it and you just don't know what you're going to like when you get into radiology or if you end up even wanting to do it in the future and I just say, pick something you want to do and like, I always did the same as talented management and I think it was nice to broaden your horizon a little bit. It was just a really fun year, I think. And I think, um, sorry, the other part of your question was, there was another part to, it wasn't, there was, um, yeah, just regarding publications and something like that. You know, I'm a big believer in do research if you're interested in research. So, you know, it's difficult, isn't it? Because it's easy when I'm on the other side of it to say, don't worry about it, you know. But I genuinely didn't, I didn't do any. So that is one advantage of radiology. So it's not, it's not hugely research driven um specialty. So if you want to do academic radiology, you can do and you can do lots of good work and there's lots of good work you can do out there and people you can work with. But I think you can also do very little and be a very, very good radiologist have lots of value and your people recognize that. So I personally did. I had, when I applied for consultant posts, I had one publication of which I was not a first author. I think it might have even been a case report. You know, I'm not trying to say, don't do anything, don't do anything. I just mean, like if you're not interested in it, it is an option to do. Radiology doesn't require you to do it at any point. Although you can get points for it, you can get points for it. And actually most of my publications have come in the last two years. As a consultant, oddly enough. So, um, you know, you don't have to but will it benefit you if you're interested? And you have some? Yes. And, um, similarly for psychiatry as well, um, it's not a requirement. Um, and, um, a lot of, a lot of really good psychiatrists and clinicians, um, don't have, er, publications, like Jeff said, it adds, er, it, it gives you points on the application. Um, so if your first author gives you a certain number of points for you, um, er, a second or third author, then it gives you a certain number of points. Um, and, um, I guess it does look, it gives you a better rounded, uh CV, um, and application but it certainly, um, not, er, a requirement, some subspecialties um, require you to. So, for example, for C A MHS, um, it requires you as part of your special interest a to do a systematic review. Um, and that's, that's just, um, to, that's part of the curriculum. Um, and so then that it's quite easy to get publication that way. Um, if that's a requirement. Um, and, and again, um, if you're thinking about publications now, systematic reviews are really great where just like, get yourself a supervisor and it's really, it's really accessible, um, er, way of getting a, getting a publication if you pick something relatively niche. Um, yeah, it's, it's, it's, er, an easy, easy way. Um, but yeah, not, not a, not a requirement if you're not interested in it. But like I said, really exciting, er, part of, um, psychiatry. That's great. Thank you so much. Uh, brilliant. So, I think that's all the questions that we've got. Um, if anything that's reaffirmed my decision to do management next year. But, um, offices here. Thank you so much to Hannah and Jeff for the amazing talks you've had today. I hope everyone in the, er, audiences enjoyed it. Um, we all run slightly today but I think that's fine. We, we've had lots of stuff to go through. Um, and, yeah, I mean, unless anyone else has had any closing remarks, I think that's everything. Er, everyone is free to leave. Uh, thanks n, and thanks for the invite and good to see you, Hannah. Thank you so much. Thank you very much for your time. Thanks everyone. Thank you.