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Thank you. So, hi, good evening everyone. Um Thanks for joining us today for the A Careers Talk series. Um We've got quite a bit to cover tonight. We have two excellent talks lined up, followed by an open Q and A session at the end, which should take us to around 830. Now, just before we begin, just wanted to give a very big thank you to the two guest weeks today. Doctor D Barcelona and Doctor Lawrence Ni, who have both very kindly agreed and prepared to talk to everyone today despite having very busy schedules. So we hope you enjoyed them a lot. Um We would also like to thank the MDU. You are sponsoring this event and supporting us. Most of you will probably have already heard about the MD, but if not, they're essentially one of the leading organizations providing medical indemnity in the UK and for all the medical students watching and there's lots of here, they provide lots of support for clinical placements, electives and events. Um Best part is the membership is free for medical students and there's a QR code on the screen if you'd like to scan and apply but I think that's everything from my end. So I'll pass on to Darryl to share a screen and do his talk first. I, hello. Can everyone hear me? Yeah, you can hear and see your slides. Yeah. Yeah. So good evening everyone. Thanks for having me on the, on tonight's session. So for tonight I'll be discussing about general surgery or pathways in, uh, entering ST three and just to give you a quick talk about um having a, a teaching fellow job and what are the benefits of doing a teaching fellow year? So, first of all, for those who haven't known me yet, I'm Darryl. I am the current, the current surgical teaching fellow and a general surgery registrar at Saint Mark's and Ing Hospital London Northwest University Healthcare NHS Trust. And I'm also a clinical teacher for Imperial College School of Medicine. So for tonight's session, I subdivided them into four parts. So the first one would be, what is general surgery just to give you just a really quick overview of what is general surgery. The second part would be the route towards becoming a general surgery. H SD high specialty trainee or ST three. Number three would be being a surgery teaching fellow and experts. And four is how to apply for clinical teaching fellow jobs. So for those who are interested or for those who are wondering what is general surgery. So general surgery is one of the largest surgical surgical specialties in the UK, it comprises 25% of all UK consultant surgeons. So after general surgery, the next one would be t but for surgical specialties, general surgery is the largest one. So it covers a wide range of areas and it has many uh surgical specialties. We did emphasis on acute abdominal problems. So general surgeons are essential to support a and departments and are particularly needed in remote rural settings due to the broad knowledge and skills. So general surgeons are also important in trauma services in which they deal with injuries in the abdomen and chest. And apart from that one, they also carry a lot or a large number of elective operations. So this is just an overview of general surgery, subspecialties in general. So it is important to note that all general surgeons are trained in emergency general surgery. So, subspecialties involve the gi tract from the esophagus to the anus organ transplants, breasts, endocrine surgery. So subspecialties, the common ones would be, for example, breasts which deals mainly with the assessment of large number of patients with breast symptoms and surgery on breast cancers often including reconstructive procedures that do not require plastic surgery. Colorectal mainly deals with the lower gi. So these are mainly diseases for the colon rectum and anal canal and particularly manage uh colorectal cancers. Endocrine surgery deal with thyroid and other endocrine glands, just adrenals, upper gi uh surgery for diseases affecting the liver esophagus and stomach. And they also cover uh obesity surgery or bariatric surgery and uh major cancer operations for upper gi usually done in regional specialist units. And the other one would be uh transplant surgery which mainly deals with kidney and liver transplantations. So the second part would be the route towards becoming a internal surgery, uh training or HD. So I have this thing that we call the traditional pathway and the alternative pathway. 83. So let me just show you the diagram. So two pathways would be we all start with, you know, finishing med school. So that's usually 5 to 6 years. And then afterwards we enter into a a two-year foundation training program. That's yeah, F one and F two. So let's start with uh digital pathway first traditional pathway. That's just how I call it is uh finishing or applying for core surgical training. So core surgical training is basically a training job in a hospital setting with rotations covering a range of surgical specialties. This is a type of a training job. So sometimes C SDS may be themed towards one particular specialty or subspecialty. So those things that we call that um ge general surgery theme CSD or TNL, the CSD. So it depends on the type of training program. So after doing your two years, of course, surgical training and by fulfilling all the requirements needed for the completion of CSD, you'll be a awarded, you know, the completion of core training. So trainees wishing to continue the surgical training at a specialty level must complete the membership of the Royal College of Surgeons examination or the MRC S examination. MRC S is to do part examinations. It's uh it's part A and part B, part A is, is a, it's, it's a type of F CQ type of questions and part B is an osteo type of uh of examination. Uh after finishing MRC S examination, you'll be able to apply for high surgical training. So specialty training and surgery which spans around uh ST three to se five. So it's usually a five year training program. So during this five years of specialty training, many surgical trainees take the time to complete either an MD or phd in area of interest to make the applications more competitive for future consultant posts. Others will do a research fellow, teaching fellow jobs and towards the end of the higher specialty trainees in the final two years of their training, specialty trainees must take the fellowship at the Royal College of Termination or FR CS examinations. So that's the traditional pathway on entering the uh high surgical training for general surgery. The alternative pathway as I call it is basically after your foundation program, if you are unable to apply for CSD for some reasons or circumstances, for example, you are unsuccessful in gaining a CSD post or you have too much surgical experience because we have a ceiling, we have a maximum limit for a CSD application. So it's 18 months, post foundation. So for those who have more than 18 months of surgical experience, you are, should I call disqualified for applying for the traditional course surgical training. And the third one would be if you have done some initial surgical training overseas or outside the UK, so you can do the alternative pathway. So alternative pathway is basically looking for a trust grade job or nontraining job. So if you go to edit website, you will be able to see jobs such as junior clinical fellow in surgery or locally employed doctor or trust surgery. So basically sho jobs in surgery. So after staying around 1 to 2 years there, if you have a, you know, you, you should look for a supportive department or consultant and you, you can ask them to support you to meet all the competencies required for the certificate of readiness to enter high surgical training or we call it alternative certificate of core competence. So if you are doing the alternative pathway, the first thing you should look for is a supportive department or consultant who will be willing to sign or to support you in the achievement of competencies in the Crest form and is willing towards the end to sign you off on those. So the minimum months that you should be working with our consultant, in order for you for your Crest form to be valid is a minimum of three months. And I suggest when you are opting for the alternative pathway, you should also do some rotations with the nontraining job. So you're just following the traditional CST uh training. So you can try to rotate with other specialties such as TNL plastic surgery, your surgery, ent urology, cardiothorax, vascular and oral and maxillofacial surgery. Try to do it for a minimum of four months of at least two specialties as the ST three application rotation with at least two other specialties for a minimum of four months will give you points for that one. So it's part of this co matrix for ST three applications. Then afterwards, once you gain your quest form, basically also do the MRCS and then apply for high surgical training in ST three. So it is just a photo of what a crest form looks like. So competency out there. So the consultant needs to sign you off, you should be able to demonstrate all of those in order for your quest form to be valid, right? So always remember that regardless of what pathway you choose as a medical student or more. So as a foundation doctor soon, you should get involved yourself with theaters, you know, put him on the E log book. So if you don't have one soon, you should create one, attend surgical conferences, quips, make some clips and audits, presentations and publications and of course uh teaching, I always advise medical students and foundation doctors that they should always try and aim for the core surgical training pathway. That's your main priority. But as I've mentioned, if you have those other circumstances, that because of this, you are unable to apply for the CSD pathway that you can opt for the alternative pathway. So the third part would be surgical teaching fellow. So basically surgical teaching fellow, also known as surgery education fellow for some trust or clinical teaching fellow in surgery. So basically these are doctors or surgical trainees who spend a proportion of their time teaching undergraduate or postgraduate doctors, undergraduate medical students or post graduate doctors. And often there is an opportunity to continue some clinical work. So it's not all about teaching. So you can continue some clinical work alongside teaching commitments, but how much and in what specialty will depend entirely upon the individual job. So for example, in my current role as a surgery teaching fellow at uh London Northwest and it's just trust. So my job plan is 5050. So it's basically 50% teaching and 15% clinical work. So 50% teaching is fully served, teaching uh the imperial undergrad medical students and the other 50% will be clinical, which is divided into clinics, theaters and research. So there are a variety of possibilities that comes to and who I am teaching. As I've mentioned, I am teaching both undergrad and post grad doctors. And it is a important to take note that teaching fellow jobs are not only for surgery. So pretty much all specialties have their own, you know, teaching fellows. And we have also the more general role such as for example, simulation teaching fellow or uh the Medical Education Academy fellows. So these are just some roles that you are required to do as a uh teaching fellow. So teacher, clinician mental role model examiner, sometimes they are asked to examine medical students for the OY and of course, the others will be you know, leader, innovator, academic facilitator, organizer, researcher and learner. So just quick overview. So I want to do a teaching fellowship. So it is possible to work as a teaching fellow at any stage of your career. But most often doctors will take time out between training blocks to do this. For example, after after completing your foundation years, foundation program, some teaching fellows will do an f three year as they call it. So some would do it full clinical, but some will apply for clinical teaching fellow posts. Some will do it after the core training, for example, after core surgical training after the MRC S examination and before applying for high surgical training, they will do a teaching fellow post and sometimes even in between high specialty training, they some teaching fellows do it as an outer program experience. So sometimes depending on the clinical component of the post, for example, in my current job, um they want us surgical teaching fellows who at least the level of an SE three registrar as they will have to manage clinics as well as to be able to do at least some mind independent operations in theaters. So why, why do we do, why, why do a teaching fellow year? So first of foremost, it's one of my main reasons why I did a teaching fellow here. So I want to build up, build up my portfolio because that time, I don't think my portfolio C is competitive enough for the se three application process. So a teaching fellow post will give you the opportunity to combine clinical practice with teaching, which will further develop your experience and build your portfolio. You will also like to have the opportunity to of course decide and deliver a prolonged teaching program. So minimum three months at least. So as a teaching fellow, you'll be able to do a teaching program throughout the year which can score you maximum points on many specialty applications. And there are a whole host of skills like think of communication, teamwork, leadership that you can talk about during your ST three interviews. And you might also while doing your teaching fellow job, you might also be able to do some quality improvement projects that you can present in conferences in relation to medical education. The second reason is you can develop some valuable skill. So being able to teach is important in many walks of life, but particularly as a doctor, we all have, we will at least have been involved in teaching in some shape or some kind. So even if it's uh teaching something to appear or junior in a mid ward round, it's still teaching. And after all, the Latin word for doctor is dri, which basically means a teacher. So apart from that one, you'll be able to gain more formal experience and develop your teaching skills to the next level. Of course, you'll be doing this for the whole year and uh you can develop skills in deciding implementing and evaluating programs and of course develop some leadership and management skills. Third reason is you can gain some additional qualifications. So some teaching follow roles fully or partially for a postgraduate qualification in medical education such as APG CERT, some will do it up until the master's master's level. And you know this additional qualification not only gives you some extra letters on your name, but it it will help you give you some valuable skill on clinical or medical education. And of course, with a bonus of giving you some extra points on specialty applications. I believe for the last cycle for the se three applications they awarded at least one point if you've done APD cert. And uh of course, apart from the qualification, you can also try to apply for membership under the uh Faculty of Higher Education Academy or the uh Medic Medical Education Academy. Uh number four is change of work environment. So some trainees will do a teaching fellow year to have a break from board work and on call. So, but you have to take note that it will all depend. So some teaching fellow jobs will, will still have an on call commitment with them and some would have no, you know, on-call commitment. That's all in my present job. I don't have any oncall commitments because of the reason that I teach students at least 2.5 days a week and then another half day will is meant for teaching. Uh the foundation doctors rotating in surgery and their mean two days will depend on what clinical task I need to do for that week. So one pro of is of course, having some time away from war can provide at least change environment or what can break from the chaos of a clinical environment, giving you at least a chance to distress and maybe even have, you know, a proper lunch break for a change. So this is one of the reasons why I also did a teaching fellow. Yeah, because over the past before I did a teaching fellow. Yeah, I did almost two years of a clinical fellow job in general surgery. And I did a lot of phone calls and I became a bit of burn out of doing a lot of those on call. Number four is of course uh flexibility. So when not teaching or involving activities of medical education or clinical work, teaching fellows generally have more autonomy over their time than they would in training programs. So for some posts, there is a flexibility on job planning. So flexibility and job planning is basically you have your own job plan. So in my current role in my clinical side of things, I am left to, you know, create my own job plan. So I can do myself, you know, book myself in theaters on one day, the other day would be in clinics, the others, I can do some research and stuff like that. So basically this flexibility on job plan and of course, this work life balance, you can also take this time, this, you know, this time for specialty decision making and CV strengthening. So that yeah, you can think about, you know, what do you really want to do? What specialty you want to commitment, commit with? This is going to be, you know, another five years, 5 to 6 years of high, high surgical training. At the same time, this is the ty type of specialty that you will do for the rest of your life. So you should, you know, this will give you at least enough time to think if you really want to go into what particular specialty. So how do you apply for a clinical teaching fellow job? So the type of teaching fellow and racial clinical practice, the teaching depends on the employing trust. So all teaching, clinical teaching fellows are employed by NHS trusts. So some specific posts are very at least rigid on what you are asked to do and some offer more flexibility than the others. So jobs are advertised between mostly between November and March before the officials start the following August the following year. And uh some keywords that you can search for, you know, when you try to look for a job in NHS JOBS is just put on teaching fellow, education fellow, simulation fellow. And when you search, you know, the results will, you know, show you what type of teaching fellow is. Some would be generic one, a general one, some would be geared towards one particular specialty. For those who are going, you know, intending to apply for a surgical specialty. Try to apply the ones who have a, you know, for example, surgery teaching fellow or teaching fellow in surgery or something, a surgical component because it will divide your time in some teaching and some clinical work which will help with building your portfolio, especially if you need some cases, especially theaters in your notebook, you need, you need those for your uh ST three applications. So when looking for teaching fellow jobs, you should always be clear on how much clinical versus teaching commitment you want because some would have have more teaching commitment versus clinical, some would have more clinical. For example, some would have at least 60% clinical and just 40% of teaching, some would have 80% of teaching just 20% clinical. Some are 5050 some don't even have any clinical commitment at all. There is also a type of a, a teaching fellow. We call this medical education fellows, but they are employed usually by med schools and these are purely academic fellows, so they don't have any uh clinical commitment with them. So when you are shortlisted for short listed for interview for, you know, for when you apply for teaching college jobs, you should always highlight your experience in teamwork, leadership and management and more importantly, emphasize your teaching experience. So teaching does not have to be formal teaching. It can be also informal teaching. For example, when you teach your junior colleague in a, you know, in a small teaching session or sometimes even as foundation doctors, when they are medical students also rotating in the or having a placement in the ward, do some teaching in there. But it's important to always have an evidence of your teaching. So you can have this by, you know, asking your audience with some feedback in teaching because just saying that you did some teaching would not suffice in your training applications. It has to have an evidence. So you can have these by asking for a documented uh feedback. So I think that's just basically it is just a an overview. And of course, if you have any questions, you can, you know, send me anything in my email or just that's my ex or Twitter handler in there. Excellent. Um, thank you very much for that d it was really informative. Um, I think we'll probably give you questions at the very end. So we might just pass on to doctor Nick first and then we'll do questions after. All right. Ok. Thank you. Thank you. Ok. Hello, Yvonne. Um, oh, I'm so bad with this. How's that? Yeah, that looks really good. Is it, is it full screen? Uh, yes. Yeah. Ok. So my name is Lawrence. I am a general surgery registrar in the South London Deanery. And thank you to, am for inviting me to talk about a Korean General Surgery. Um, some of the things that I'll talk about, uh, will be reiterating what dry's already talked about. Um, and, and some of the things I'll, I'll, you know, try and fill in, uh, some of the gaps as part of the, the whole pathway. Um, and hopefully that you'll be able to see the whole picture basically and piece together the puzzle cos it is, you know, it, it is, uh, you know, a mine and it's difficult to navigate and hopefully, um, both our talks together. Um, you'll be able to, um, appreciate the whole pathway of general surgery. So I'm going to talk about mainly three things. Firstly, I'm going to talk about a career in general surgery. This will mainly be reiterating what Darryl's already talked about. Um, the second part, I'll talk about is um a pathway towards becoming a consultant surgeon. And thirdly, um I'm going to talk a little bit about the application process for course surgical training, which is a fundamental part of the surgical training pathway. And it's the first part where you pick up all your basic skills. Um and it is the part for any future general surgeon that you should be aiming for. Really. Ok. So, um this has already been touched upon but there are 10 recognized surgical specialties of which general surgery is one. Um, a and there's plenty of others which may spark your fancy. And, you know, general surgeons is a great specialty even now if, you know, you know, I ii really love my job and if someone asked me, would you change your career, er, er, my answer would definitely be no, you know, 100 times out of 100 you know, if you asked me, would you change your job? I'd, I'd essentially say no. And there's something for everyone in general surgery. Um, you know, if you look at these pictures, it's so diverse. Um, and the, there's a unifying feature of all these different subspecialties within general surgeries that they all go through the general surgery training pathway of some sort, whether that be the traditional pathway or the alternative pathway. Um, all of these people will have done general surgery at some point of their training. So the first one is, um, to clear stab wound to the abdomen. So this is essentially depicting a trauma surgeon. Um So the typical trauma surgery would probably um do their early years in general surgery, doing things like appendicectomy, cholecystectomies, laparotomies, um colectomies. And then towards the end of their training, they'll go on to, to subspecialise within trauma and, and, and mainly spend most of their time within one of the four major trauma centers in London. Um The, the next one is a transplant surgeon. Um again, they'll mainly do general surgery towards the uh early years and then further subspecialise in transplant. Um The next picture depicts a, a robot which, you know, a lot of surgery is now heading towards robotic surgery. And um you know, general surgeons used to be essentially skilled at open surgery, but with the advent of minimally invasive surgery, um laparoscopic surgery came about. Um there's a few procedures we can do endoscopically as well. And the next stage in that evolution is robotic surgery and robotic surgery is becoming a big thing taking colorectal surgery. Um You know, there's, there's space for it in, in HPV as well, I believe. And upper gi surgery, to be honest, a lot of procedures will end up becoming robotic in the near future. The bottom picture here is breast surgery. Um you can see a mastectomy and you can see some oncoplastic reconstruction. And the final picture on the right of the screen shows a kid with an umbilical hernia and um general surgery of childhood is a uh subspecialty within general surgery. Uh, the pediatric surgeons have, have really subspecialized and they've taken a lot of the real kind of subspecialist, pediatric bits, but a lot of the bread and butter pediatric surgery is still done by general surgeons. So things like um, hernias, inguinal hernias, um the orchidopexies, um orchidectomy, those sort of things, circumcisions as well. Ok. Um, this has been talked about already, but these are the subspecialties within general surgery again. So remember really the key is that all of these people are competent in emergency, general surgery and elective general surgery. And then they further subspecialise into one of these. Um one of these uh subspecialties, colorectal esopha GST H PB, breast general surgery of childhood endocrine renal transplant with dialysis access and former surgery. And, and just as an aside, if, if you're, you know, gonna be super super subspecialist, you can even come off the general surgery on call ROTA and not do any general surgery. Um These tend to be, you know, the really professorial types um and pertain to these three subspecialties. So for example, if you do breast surgery with oncoplastic reconstruction, often you can come off the general surgery on call ROTA. Similarly, you can do so with multiorgan transplantation and retrieval and HPV and liver slash pancreas transplant. Um typical activities um is you'll be doing at med school anyway, shadowing all sorts of people doing elective theater lists on call, which often includes uh seeing patients in the emergency department and also emergency operating, um, ward rounds, endoscopy clinics, M BT meetings and teaching slash training courses. And one thing which II find very cool about general surgery is, is the way it's heading. And yeah, we we're still definitely going to have open surgery. And that's the picture in the middle, open surgery is, is, is great you get particularly in general surgery because that largely pertains to the abdomen and um abdominal anatomy is, is just amazing. Um And a lot of even now district general hospitals are now starting to get the robot. Most big teaching hospitals will already have a robot, but a lot of um district generals are starting to get them. Um even my local hospital, which I'm currently at, which is Croydon Hospital. He's in Croydon. Oh, Croydon must be so poor, but actually they're, they're in, they're gonna get a robot in the next few months. So, so this is where it's heading. And um VR could potentially be a big thing uh maybe in um 3d uh surgery or particularly in training of surgeons. Um and simulation uh is is going to be a key factor in training surgeons of the future. The private work is also pretty good for general surgery. As you can see, this is a little bit odd. This is taken from the Royal co surgeons website. Um the hernia repair is actually one of the most common operations that all surgeons do followed by hip replacement, followed by knee replacement and gallbladder removal. Um So even if you are, for example, a, a highly specialist liver transplant surgeon, you can still do a lot of private work because you are trained in general surgery, you can do hernia repairs, you can do gallbladder removals, you can take up lipomas, um, you know, generic lumps and bumps. These things are all part of your skill set and, and it's, it's good for private work. Ok. So I'm mainly going to be talking about the generic training pathway or the traditional training pathway as uh Darryl mentioned, mainly because um that's the pathway I went through and I don't really have that much knowledge on the alternative pathway. Um I think most of you will be in medical school, which is uh the 4 to 6 year part on the left of the screen and you'll be in various stages of this um of medical school. After that, you then go into foundation training, whereby you spend two years rotating amongst a variety of specialties, some surgical, some medical, some community placements. And then after that will be your first real application. So you don't get an interviewer for any, you know, for any training pathway. Um Other than when you start medical school, so you'll have an interview to get into medical school and then your next interview will essentially be applying for the co surgical training pathway. Or if um if you want to apply for a specialty which, which has what's called improved or run through surgical training, you can apply for that as well. So specific, especially such as neurosurgery, I believe and cardiothoracic surgery, they offer this improved surgical training or run through surgical training whereby you just need to interview at the beginning and you can go all the way through training, um, before getting to CCT, which means certificate of completion of training and thereby entering into the specialist register. And you're eligible to be a consultant surgeon within that specialty. Um If you go through er, the most common pathway, um you'll apply for co surgical training, which is two years, you'll go through a variety of surgical placements depending on if you are a themed trainee or if you're a generic trainee. Um, myself, I was a generic called surgical training, meaning I rotated through different things. However, I, to be honest, I ended up doing a lot of general surgery anyway, because I ended up swapping out of some of my other specialties. For example, I swapped out of my orthopedic placement for more general surgery. So I ended up doing actually a lot of general and a lot of vascular surgery. Um, and then after course of surgical training, two years, you do a further application with an interview for specialty training ST three to ST eight. And at the end of ST eight, you should CCT um and get your certificate of completion of training and become a consultant after that. So that's the whole pathway. Uh This is the same thing again, um But in a different slide and again, this is the same thing that this is a hee official um infographic on how it works. So the top one here is general surgery. This assumes you've completed the foundation program. So you enter for core training, do two years. And at that point, you should have completed the MRC S membership of the Royal College of Surgeons. And then you can enter and apply for higher specialty training and and other specialties. For example, cardiothoracic here, the third row and also neurosurgery. Um You can do this run through program whereby you go all the way from ST one, all the way to ST eight uh without having a further interview. Now, what is course surgical training, course surgical training is designed, it's a program essentially designed to bridge the gap between your foundation training and higher specialty training. And the whole point of course, surgical training is to develop basic competencies required for um any of the 10 surgical specialties. A lot of the core surgical training programs are now themed. So for example, you can have an orthopedic themed CST post or you can have plastics themed general surgery themed urology themed vascular themed. And in these themed posts, you'll end up getting more of your desired themed specialty. So, for example, if you've got a general surgery themed course, surgical training post, you'll end up doing, you know, a little bit of general, probably a little bit of urology, probably a little bit of vascular. And then for your second year, ct two year you'll probably, probably do mainly general surgery. Um, so the third bullet point, it's a national selection with a common curriculum and this curriculum is basically on what's called the I SCP. It's the, it's a website essentially, um, er, called the Intercollegiate Surgical Curriculum program, which essentially allows you to log everything and, um, essentially have an electronic portfolio of all the things you've done, which includes things like work based assessments, like your texts, your CBD S, that sort of thing. It's all logged on, on the ICP program portfolio. And the aim of CSE is to develop skills and knowledge as well within your specialty of choice. Uh, uh, these, you can, you can, I mean, I guess you can take a picture of this but, um, it's not really to be prescriptive or anything, but these are the CST objectives. So you have objectives for CT one and you have objectives for CT two II. Think one of the, the benefits of the traditional pathway over the alternative pathway is that you're benchmarked every year. So you, you really have to be on top of it. Whereas on in the alternative pathway, you have to, you have to really be self motivated essentially to be able to all the same things and prove that you are as competent as someone equivalent in the traditional pathway, which is definitely possible. It just requires a lot of motivation. Whereas in the core training pathway, you, you have to do it otherwise you get kicked out of the program. Um These are the CSE competition ratios. Um So on the left here, you can see a table going from 2016 all the way to 2023. Um The number of applications has slowly increased every year from 1622 all the way to 2539 the posts have remained roughly similar in the 6 100s. Um I mean, if anything's slightly reduced and that means the ratio of applications to posts has gone up slowly over time and this is on the on the right. It's basically the same thing but in graphical um graphical form where you can see the the competition ratio in blue, slowly going up. Um whilst the posts are remaining roughly the same, but even then a competition ratio of 4.17 is actually it's not too bad considering um some of the other specialties, this ii can't remember which website I took this from. But um as you can see, um the most, actually the most competitive specialty is community sexual and reproductive health. But that's actually because there's only like, I don't know, one or two posts in the whole country. Um And you get a lot of applicants for that, whereas for things that are called surgical training called medical training GP Practice, um There, there are a lot of posts and there's a lot of um there's a lot of applicants. Um So, so actually course training fits in somewhere in the middle. So you shouldn't be put off from applying at all. Um These are the CST numbers per deanery. Um A deanery is basically an area um which includes multiple different hospitals in different areas. So, um for example, I, I'm er when I was in core training, I was a London CST trainee. So there were 89 to 93 posts, but that's in 2024. Um It's roughly similar. So when I applied it was 2020 and it is, it was roughly similar numbers. I think there were about 90 posts for London. Um altogether there's, there's 600 as you can see and these are how it, how the distribution is spread across the UK. Um This slide is just to depict it. It's a little bit confusing. I know it's there, there's a lot on this slide, but essentially when you make your application, um you basically end up getting sent an Excel spreadsheet with all the 600 jobs in the country and you can see this Excel spreadsheet, you know, 100 and 21 100 and 22 all the way down to 100 and 64. But it will go on to 606 100 jobs in the country. And essentially you need to rank all those 600 jobs in terms of where, which ones you want to do. Um, if you don't want to rank some of them, that means you definitely won't be able to get them even though you, you interviewed well enough. Um So if you, if you put only for example, um I don't know a certain number of posts like 10 post 121 all the way to um 131, then you'll only be considered for those posts. Um I think a lot of people just rank all 600 to be honest, but it takes a lot of time. Um These two at, at the bottom here, these are just examples of some posts that are offered uh by the course surgical training program. For example, you can get an ent themed post in the Northwest Deanery, which is the Manchester area and Liverpool area. And in CT one, you do upper gi for four months at Bolton, you do Ent at Blackpool for four months and you'll do some plastic surgery at with Inshore Hospital for four months. And then for your CT two year, you end up doing a full 12 months of Ent at the Royal Lancaster Infirmary. Um This is a CST generic post from the London Deanery. Um for example, you'll do four months of trauma orthopedics at Croydon Hospital. You'll do four months of general surgery at Saint George's Hospital, four months of itu at Saint George's Hospital and then CT two posts. Um you then have to reapply uh and, and see what else is in the pool of the London jobs essentially. Um So each one of these, so this ent themed post, this CST Generic Post, this each one of those will be a line on this Excel spreadsheet. For example, this ent the post might be line 121, this CST Generic Post might be line 256, for example, and there's 600 of them and you, you basically just have to go through 600 jobs. It's quite annoying actually. But um um like I said, you don't have to rank all of them. Um You can only rank, you might want to only rank the ones you definitely will want to do, but a lot of people do end up ranking all 600. Um No, in terms of entry into course surgical training, it's, it's very much changed since I did it. But I believe, well, this is up to date as of 2024. You basically, there's an exam you have to take called the M SRA and this is a generic exam. A lot of specialties now use the M SRA to determine whether or not you can be shortlisted for an interview. I think the GPS do it. I think the radiologists do it. I believe um I believe the obstetrics and gynecologists do it. Um But essentially you take this generic exam and if you score well um enough compared to other applicants, then you will get shortlisted for an interview. Um And then once you're eligible for interview, you then have your interview of course. But your final score is determined by three things. So 10% goes to your M SRA score, 30% is waited for your portfolio and 60% is waited for your interview. Um So really the M SRA is just to determine whether or not you get an interview and then it contributes 10%. But really you wanna, you wanna smash your portfolio in the er and the interview because these represent 90% of, of your points. And this table here below this is essentially how the portfolio, uh how, how your portfolio is scored. So there's a lot of different things. Um Darryl's touched upon a lot of them and you, you do need to make sure that whatever pathway you go through, you know, you, you basically keep on top of all of these things. Um So you basically need to log your operative experience, you need to go to surgical conferences, describe your surgical experience, you need to do quality improvement projects and presentations, publications, do some teaching and some training qualifications. A little bit on the interview. It's, I believe it's a, um, it's an online interview now, mine was an in person interview at the time, but it's now online. Uh, it's 20 minutes and you essentially get two stations. Um, there's a 10 minute management station and a 10 minute clinical station, the management station. Uh, to be honest, you'll, you'll kind of go through this near the time, of course, but it's, you know, an example might be your, your consultants turned up to work drunk or something like that. Um or uh it's difficult thing from a scenario, but um maybe uh a colleague keeps turning up late to work, that sort of thing. How are you gonna deal with these sorts of situations? And then the clinical scenario is um basically a, a, an, an unwell patient or a trauma patient in terms of the timeline. Um So interviews are usually early on in the year. So uh the interview for 2024 took place uh last month or two months ago in February. That means you end up applying um about six months before that. So you end up, you end up applying um six months before the interviews. So, you know, this round would have been October 2023. You um end up doing the M SRA, which is the exam, you then get invited to interview if your M SRA was successful. And um you go through the whole process, it's a very long process. But ultimately, it, you know, um, you need to prepare early, basically is all I'm trying to say. And I think most of your medical students that my tips for a competitive portfolio, er, when I say tips to clarify, what I mean is things that you really, you should, ought to do because actually these things that I've written down, um, if you, if you do want to pro surgery are very easy to do and actually, they don't really take that much effort. Things like, for example, quality improvement projects, um audits, publications presentations, they, they take a lot of effort and they're really difficult to do. They, they, you know, it's, it's not something you can just bash out in one day. For example, it takes, you know, months and months of ongoing hard work. But these are the sorts of things that you can actually do quite easily. Um uh And of course, the first point is make sure you start preparing early. So the first thing you can do is is keep an E log book of all the operations that you've been involved in. Very easy to do. You just go on this E log book website, sign up and um basically every single operation that you get involved in just lock it down very easy to do. Next thing, join the local University Surgical Society. Um I don't think this actually offers any points, but the reason why II would definitely recommend joining the University of Surgical Society is because they, they, you know, it's a community of like minded people. Um They will hold talks such as the ones um we're giving today and they'll be much more informed about and give you opportunities to do interview practice or um attend, you know, advertise things like conferences. You just know much more about the landscape um of current applications basically. So I'd definitely recommend doing that. Um I would definitely consider attending some R CS courses. They are a little bit expensive but II do believe they're highly worth it. So, um the one you should probably do as a, as a student is the surgical skills for students. Actually, it's not too bad, it's about 100 and 50 lbs. Um, and you do learn a lot. The one which most p er, er, you know, it used to be a uh a requirement when I applied was having done what's called the basic surgical skills course. Um This is a, a, I think it's a three day course or was it a two day course? And you go through basically some of the, the basic surgical skills that you need for course of surgical training. Um The surgical skills for students is essentially the day one of that and it is very useful. Um, a good conference you can attend is the Asset conference. That's the association of surgeons in training. Um They're very trainee friendly, they're very medical student friendly. Um, you'll, you'll see a lot of similar people, er, there during the conference and, uh, make sure you do your elective in a surgical specialty. Um, II did my elective experience in Hong Kong at Queen Mary Hospital and I did mine in former orthopedics. Ultimately, it didn't matter that it was informal orthopedics rather than general surgery. You know, I've, I've shown that I've done a surgical elective and I, I've got points counting towards that. Thank you very much for allowing me to talk. Uh This is my email here and I welcome any questions. Uh ok. Thank you very much for that talk. Do. It was very informative and really interesting. So, um for both, both Celona do, we've got time for questions now. Um We'll just wait to see if we've got any coming through the chat. If not, I've got a few questions from people on the floor, I'll read out too, but just checking now. So nothing from the chat. Yeah. So I'll just start from the floor. Um Henry asked what are the best ways to get involved with research and, or quips as a medical student? Um, so there's research and, or quips quality improvement projects. Yes. Yeah. Um, actually, it, it, it, it is quite tricky actually. Um, as a medical student, um, you really have to put yourself out there and, you know, ask people who, you know, professors, consultants. That sort of thing is, is very tricky. I do think it becomes easier as you go through your career. So, you know, as a foundation doctor F two core trainee the opportunities, basically, they present themselves easier to you. Um I would say as a medical student, um what I did anyway, um my um story is mainly that I ended up doing an indicated BSE which actually was a compulsory part of my university course. Now, as part of that indicated PSE I ended up doing a, a fairly surgical project. It was actually an ent and through that project, I, you know, I got to know consultants and um they involved me in their research projects as part of the BSE and outside of the BSC as well. Um But if you know, if you don't have the opportunity of doing that indicated PSC, then I would, it's difficult, but I would, I would recommend going to your clinical doing your clinical attachments. Basically, that would be a year 345 or six. going to people like clinical teaching fellows or um consultants who you're attached to or your educational supervisors and, and just asking them basically if they've got any good projects to get involved in and don't get disheartened if they say uh no, you just, you just gotta keep asking basically. Oh, that would be my advice anyway. Mm No, I think that's just really useful honestly, especially with lots of the the medical students on clinical placements. So that's definitely good advice. Um, d do you have any, any thoughts about that? No, I agree with Doctor Nip. Uh, it's all about asking people around in your placements, you know, and, you know, it's like, it's a bit tricky because you have to ask a lot of people around and for publications, researchers and audits. Sometimes they take really long time and as medical students on your attachments at most, maybe you just stay in one hospital for six months. And sometimes these researchers take minimum six months, probably for just one publication. So they take a long time. Yeah, definitely. So, um thank you for that as well. Um All I've asked, uh what would you say is the biggest challenge you've faced in your career so far? Um Which is feel free to answer that either. Um Yeah, that's a good question. Um I would, I would think being on the surgical training pathway um is, is a marathon and I would say um the biggest skill um really is, is patience. Um when you're, you know, even I II experienced this as a medical student as well. I remember being a medical student and being very impatient, I just wanted to, you know, graduate and, you know, be part of the team, do work and um basically get through as quick as I can. Um And I still get this now. Um I, you know, get feelings whereby I just want to, you know, do operations, you know, basically, um essentially step up and do, you know, you know, be above my pay grade, essentially. II you know, I just want to operate, do these things. And often, you know, when you get AAA big case that you really, really want to do, um often you don't get that chance because um you know, you have to realize that, you know, you things can go wrong and um there are limitations as to as to what you can achieve yourself. And often your consultants will kind of do most of the operation and you're kind of left kind of assisting, for example. And you know, that feeling of, you know, being very hungry for more is something you really have to kind of keep in check because it really can um it can make you very disheartened and um it, yeah, it just, yeah, yeah, can make you feel very bad at times. I'm not sure your family's playing that very well. You can kind of similar feelings. Yeah, I do share the same sentiment as you are constantly trying to meet this expectation, especially from your seniors or your consultants. And uh Nixon, did you say uh challenge which I have, you know, experienced or challenged in, in relation to my career up to date? Is that one of the questions in there? Uh Yeah, so I think it's either, yeah, so one of the challenges, you know, in relation to my career up to date because I initially did II don't know exactly what I told you when you were having a placement in any hospital, but I initially did my surgical training from overseas. Yeah. So in order for me to apply for three training here, I have to offer the alternative pathway because when I arrived at the UK, at that time, I was already past the 18 months, you know, mark of the CST application. So I'm basically banned from applying for CSC at that time because I II think I'm already the 24 months of of having surgical experience. So I had to opt for the alternative pathway in order to have all my competes signed off and it was really a challenge. So you have to be self motivated in there. You have, you, you are the one who is, you know, in charge of taking care of your portfolio. So there there's no benchmarking. So you have to set, you know, objectives for yourself and you know, do some things that, you know, accomplish tasks in order for you to meet them. So that's one of the challenges I had to face in my career so far. Oh, wow, that's very interesting. So thank you for sharing that. I think it's really nice to hear both of you some of the challenges you're facing and being really honest about that. Not necessarily things you've always consider, but two really important things to think about as well. Um So thank you guys. Um N has asked in the some a nicer question, what would you guys say is the most enjoyable part of your career? So, on the opposite side, perhaps, well, for the uh most enjoying part of my career is probably because one of the reasons why I went to med school in the first place is because I wanted to become a surgeon. So I want to, you know, operate, I want to do things with my hands. And one of the good things about surgery is you get this instant, sometimes you get this instant gratification of seeing what you have immediately done. For example, when you operate or something, for example, when you remove a tumor or you do some hernia operations, you afterwards POSTOP, you'll be able to see the outcome of what you did. So there's instant gratification in there and you can actually see, you know, some improvements on what you have done for the patients, especially if you see your patients where they come in the hospital, read them well, or they are in pain or have these sorts of symptoms. And then afterwards you manage these patients do some operation, take care, you know, see them POSTOP and then afterwards be able to discharge them, you know, now improve and better than when they first came to the hospital. I think that's one of the good things about having a career in general. Surgery. Yeah. And I think that that is one of the nice things. So you can definitely see, see the results of your work, like, really quite quickly. Um, Doctor Nick, what would you say is the most enjoyable part of your career? I think very much the same, um, being able to have a, a, you know, a task focused job where you can do something and see the results of it. I think it's very rewarding and also seeing yourself improve over time is, is a very gratifying experience as well. Um You know, it's definitely noticeable. It's, it's, it's very easy to overestimate how much you will achieve in one year. But a actually if you look kind of longitudely across five years, you, you actually realize that you achieve a lot and, you know, um, actually you'll be standard by how much you can achieve in five years. Um, but if you know, if you look at a short period of time, it's very hard to notice that. But, um, if you extend it a bit longer, then, then you really do see it and that, that is a really rewarding experience. Yeah, definitely, I think definitely, as you say, more marathon, it's a nice thing to look back on the, the sort of improvement aspect. So that's great. Um Another question this one's from we wen he's asked, do you think there's any misconceptions about general surgery that you'd like to address? Um, target open question. Um I think, I think often general surgery is seen as quite, uh, not very glamorous specialty. Um, but actually, you know, II guess not. But I don't know. E equally II think it is, is really cool, you know, but as in both talks, um there's huge amounts of social specialty. You can get involved in um some of the, you know, the, the, like the pinnacle of general surgeries, things like transplant. Um, a so gastric, you know, where you're opening the chest to remove soft gastric tumors, um, robotic surgery. Um, I think this is actually quite gram but often, you know, it's general surgery is seen as, you know, especially where, you know, this huge workload. Um, you often, you have to work 100 hour weeks or something like that, but I don't think it's really that true. I think, I mean, some days the workload is not very manageable, but I think it's the same across all specialties. And, uh, I don't, I don't think general surgery is particularly more intense than, than others. Um, in terms of the workload anyway. Ok. And there were any false that, yeah, I agree with doctor Dibb. Uh, you know, one of the misconceptions about general surgery is sometimes when you say you tell people general surgery, they to think about the colon rectum anus and stuff like that one because I had a colleague before he was, you know, he was more into TN and he, he asked me that, you know, why do you want to go to general surgery? You know, the operation is all about too and stuff like that, which is basically not true as you can see from, you know, I would talk today that there is a wide range of sub specialties that fall within general surgery. So if you are not keen on colorectal, you can do some other bits. It's not just, you know, it's not just about the colon rectum. So general surgery has a lot to offer than just, you know, purely large bowels out of it and stuff like that. Yeah, definitely. I think I agree with both of you there. So hopefully that those are 22 misconceptions that will help convince you to, to do your research. I'm aware that's something you're interested in. So, um, I'm just have a look, any other questions from the Metal Chat? Um, before we wrap up? No, and it looks like we've not got any more questions from the floor. So I think what we'll do is we'll, we'll end it there. Thank you for everyone for joining. I'm going to stop the broadcast. Um Thank you doctor. Thank you doctor and again for, for the fantastic talks you gave us today and the, the Q and A session we have, um, we finished a bit early, so hopefully everyone can just enjoy their, their, their bank holiday evening. And yeah, I'll stop the broad