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Produce herself. Hi, guys. I'm an, I'm an S T seven in anaesthetics and I started my training in Devon for a CT one C T two and I came here for S T three. So an is going to be kindly speaking to us tonight a bit about what the application process is for applying to anaesthetics training at the moment. Um, so they'll be, the chat function will be active throughout. So I'll be keeping an eye on the chat. Um, but we'll have time for questions and answers at the end. Um, if anyone has anything they'd like to add, so we'll just make a start then. Great. I'll get the power point up and then you can tell me whether or not is that it working? Okay, Allen. Right. Well, hi, everyone. So, uh, Ellen kindly asked me to do a little presentation on an aesthetic training and we had to talk about what this first talk might be about. I decided we would cover on this occasion, curriculum exams and specialties. There's a new curriculum and when you get, as far as your interview for CT one, they will probably want to know that you understand what the curriculum is. So I thought I'd cover that. They might ask you a bit about what the exams entails. We're going to cover that. And then about specialties you can look at, um, delving into later, uh, sort of on down the line, uh, in your training and then in the questions and answers at the end, if you can tell us if there's a, nothing else you'd like to, to hear about. And we'll gladly cover those topics as well. So there's a new anesthetic curriculum started in 2021 and it split into three stages, stage one, stage two and stage three. Stage one is in my day, what they call the novice stage. But in my day, it was CT 12 C T two. And if you did a ccs anaesthetics, it was CT 12 C T three. And the reason they changed, it was because people were not passing the primary exam before the end of C T two. And so a lot of people were having to arrange a trust year or a locum year where they kept their skills and anesthetics up while also studying for the exam and they felt really out of the system. So this way is, is pretty good. I have to say I don't have any qualms with that. During this stage, you sit to your eye A C which is your initial assessment of competencies. And that's things like, can you put in an eye gel. Can you do, can you tube a patient? Can you do a basic spinal? And trust me, it sounds scary but you will be able to do it all. Uh in those first three months you're not on call. Uh, all you're doing is very basic procedures. Your eye aoc is initial assessment of obstetric competencies and not things like doing an obstetric airway. It's things like um doing a spinal for a cesarean or an epidural for labor analgesia or putting up Remy fentaNYL again. Sounds really daunting. I always thought I'd be that person who was rubbished epidurals, but I managed to, to pass my IOC and you do learn eventually during this stage one, you set your primary exam, which we'll talk about and during stage one, you do six months in, I see you six months of obstetrics and then the rest of it is just general lists and depending on what hospital you're in. When you're on call, you might cover um obstetrics and I see you and the general uh on call or you might just do one or the other. So stage two years S T 42 S T five. So you, after your novel stage, you would apply for S T four jobs you reinterview and this is the period where you set your finals as well. During your intermediate stage. You also do uh the specialties, some of the specialties like neurosurgery, cardiothoracic surgery, pediatric anaesthetics palm is perioperative medicine. And I see em intensive care medicine and you do three month blocks which are really heinous. You know, it's very, very short period of time to try and get everything signed off. And then stage three, if you pass your finals, I say when you pass your finals, you go on the stage three and stage three, you more obstetrics. Some people do more pain. But really, it's an opportunity for you to sort of find your, your own niche. So you might want to do more cardiac or more neuro or something really unusual like bariatric, perhaps you might have to go away to do a fellowship on that or burns that sort of thing. So the interviewers might be interested in you knowing that there's a new curriculum and it has three stages and this is the basics of each stage. Now, during each stage 12 and three, there's certain things you will cover. So I'm sure you're familiar with this guy. He pops up a lot, there's a lot of simulation at, at every stage which is great. Uh You will do uh obligatory quality improvement, some clinical governance, uh research, governance and critical literature. Appraisal is a fancy way of saying you'll do journal club. Um but there are research fellowships as well. If you'd like to get involved with them, you'll do teaching. So the teaching is excellent for primary and final exams and the teacher, the sort of peer to peer teaching. We do as well. You'll get to do that. And then things like child protection is usually done as an e learning module, like, like the same way that, uh, blood and things are, you probably already done child protection at some point. Anyway, the benefits of the new curriculum, this is the kind of thing an interviewer would maybe expect you to, to discuss. Um, so the old system novice training was CT one and two. And now by adding a third year, it keeps people in training even if they haven't passed the exam first time, some people don't, you've got five attempts at each. And uh in the past, you used to get extra points at S T three interview if you passed your exam first time within CT one and that's all gone to, uh which is a good thing because it didn't prove that you were better than anyone else. The new curriculum focuses less on a number of workplace work based place assessments and more on the quality of the ones that you do. So they hope that you go sort of more into reflective practice and it gives you a bit more stewardship over your own learning. You know, some modules you can't get six tops is because there's just not enough procedures in them. You know, perioperative medicine is more about patient interactions than performing a procedure. For example, they also now look at whether you're supervised or unsupervised that's new in the portfolio and uh the sort of 14 domains and that includes clinical things like your ability to give to do a fair way, regional anesthesia, which is blocks and things all the way through the things like teaching and management, the non clinical side of stuff, new assessments of new names as well. So I would advise you when you go to your interviews to read up a bit about what these new assessments are. You might know what they are already. There's things like halos, it's kind of like um they sign off the unit of training basically for that module, say obstetrics, you get a halo and obstetrics, the issues with the new curriculum. Uh It will be more work. Unfortunately, you have to prove yourself more for trainees and for educational supervisors and because of that, I suspect a lot of educational supervisors will drop out. A lot of them aren't in it. Uh Altruistically, should we say there's issues as to whether they'll be consistent um consistencies between departments and Dean Aries. Who does what? So who signs you off for your modules in the past? It was sort of the head of that division's the head of obstetric anaesthetics or the head of regional anaesthetics, head of cardiac anaesthetics annoy. They're, they're saying that should be your educational supervisor who might not have done cardiac anaesthesia in 20 or 25 years. So, moving on to the exams which everyone worries about. I implore you not to worry about them. No matter what specialty you picking medicine, you'll have to sit an exam. You might as well enjoy what you're studying. And if you think you like anaesthetics, then at the very least you'll enjoy learning about it. At least I did. So, the primary exam is what you sit in stage one. So it's, but into two exams there is uh an online remote written primary which is uh M C Q s and s be a single best answers. And it's, they're going heavier on the S B A s and they used to three hours long and it covers pharmacology, physiology and physics. My advice for that is just to get every single app that has MCQ and SBS and uh just do them all over and over and over and over again, you know, commit yourself to doing 80 a day or something. I don't know, you can fit them in quite easily at work when you're in theater. The second part of the exam is the Os Keys and the viva S O is, is another term for the Vyvanse. So it's a, it's an in person event again at the Royal College in London. It's a full day event. You tend to do your off skis in the morning, which is 16 stations. You have a break. Usually a fairly substantial break can be two or three hours and then there's the vivat to So it's uh three by 30 minute questions that cover pharmacology, physiology and biochemistry. You then have a break again and then maybe in our could be two hours later, you do three times 30 minute questions on critical incidents and uh things like physics, clinical measurement equipment and safety as well. It sounds like a lot, but this is all the stuff you kind of, you honestly need to learn it to be able to do your job anyway. So it's none of this is theoretical stuff that you don't need to understand. You will be interested in learning it to do your day job as it is. There's two examiners in the viva and one of them will be asking questions while the other rights and then we'll swap over. But it's important when you're answering to look at both of them in turn, um just show off your people skills. If you pass uh the written, it's followed for seven years. You don't have to like within six months at your vivat. I took a year between them. So I could get more study leave and go to more courses because I only wanted to sit them once. If I had to, you can only progressed to stage two. You once you've passed your primary, so once you do your, then then set your final. So it's a written C R Q constructive response question. It used to be essays, handwritten essays, which was awful. It's now uh, done remotely online, sort of white paper and there's quite cyst inked answers. They're not looking for giant essays anymore, but there's 12 questions with sort of sub questions. It's three hours long and that's in the morning and then in the afternoon you do your M C Q S S B A s. There's loads of examples of cr cues online and it's just a case of practicing a lot after you've passed the written, there's the final viva. So there's no off skis final stage. And again, it's a full day in person event at the Royal College. It's a lot shorter though. So in the morning there's a 26 minute five A and in the afternoon there's essentially another 26 minute five, er, with 10 minutes and reading clinical material at the start. So it's 36 minutes in total in the afternoon, but really only 26 minutes of chattin. So, um, it's, it's a very different based and by then you're usually quite good at doing fivers. Anyway, my general advice just keep practicing, practice with your friends with the vibe. I mean, practice online, practicing person, go to every event, go to, um, there's courses in Coventry, the Royal College do events in London. There's a learning for health modules that are fantastic and anesthetics and they also have mock exams at the end of them. Once you, once you get into an aesthetic training and you apply, you start paying the Royal College of Anesthetic for membership, they will start sending you journals and one of them is the British Journal of Anesthesia Education journal and it has lots of, uh, sort of units of teaching in it. And the general advice is to read every single one that's been published for the last four years sounds awful. But actually, it's not too bad and because they're very, very digestible, this is what the exams tend to be written a bite. This is what they want you to have. Red. There's a college book as well that you can order from the Royal College, you can fill them up or you can order it online, I believe. I think it's still an actual physical book might be a download. Now, I suspect it's still an actual book so that you can't redistribute it for free use. All your study leave. Don't save it for any day use it all go to all the courses you can afford and whenever you go to the, to London, go the day before they can be really bad. Fog between Belfast and London. So don't risk flying in in the morning, you can stay really, really close. There's a hotel that you can look right at the Royal College from stay in that one. It's really nice. It's not cheap, but it's worth it. Bring in earplugs and eye mask, get the hotel to give you a wake up call in the morning book. A late checkout. So that once you've done the morning exam, you can run away to your hotel room and hide like I did because otherwise you're gonna have to sit in a cafe somewhere for two or three hours. And it's, it's quite expensive um to sit in a cafe in London for that long. And it's just not feeling very sociable. I went back to my hotel room, I had a shower and change my clothes and I felt really fresh for the afternoon. And then whenever you book a return flight, it's going to have to be like an eight pm flight because you don't know when your afternoon session will finish, it can run over late. Uh I think my final Viber finished at half six in the evening. So even that was a bit of a race to get to London uh city airport. But if you're early to the airports fine, you can just drink cocktails, be glad it's all over. So once you pass your exams and your in your stage three, you can think about what sort of things you're gonna be interested in long term. Now, early on you will cover the same sort of things as everyone else. So, peri operative care, you'll see patient's before their surgery, resource and stabilization of patient's in E D, which is I think the most interesting and fun thing to do or you might go to the ward to see them, maybe they're the deteriorated on the ward, pain relief and labor and obstetric anaesthesia. I quite enjoy that. Some of you will love intensive care medicine and might go on to specialize in it. There's pain medicine, uh there's chronic pan, which is usually clinics on that acute pain, which is i patient's sorry. Chronic pain is outpatient and acute pain is usually like a war drawing for in patient's transport, acutely ill and injured patient's. This is becoming less common, to be honest, it's becoming more of a consultant led service. And as someone with really bad travel sickness, that's no bad thing. I really hate transfers and they're really scary. Um And then pre hospital emergency care that's more common in places like London. To be honest, when it comes to special interest, this isn't even an exhaustive list, but this is some of them, some of the things you could choose to go into. Um I personally like cardiac, I like obstetric anesthesia. I like pain R E A trick surgery's pretty interesting. There's things that aren't on here like uh I know there's burns actually there resource per environment. There's actually uh there's fellowships through the Royal College to Kenya if you want to do those and, and they will send you out for six months. Uh There's fellowships in the Shetlands as well, which is a remote Anesthesia fellowship. Any fellowship you can imagine it exists, okay. And uh you can go to Australia, Candida, England, you can do your fellowships here doesn't really matter. You can also just choose to be a complete generalist. You don't have to choose a special interest, but most people kind of feel themselves drawn towards something. So, would I recommend it as a job? Absolutely. It's great fun. Um, a lot of the time it is sort of sitting in theater chatting, uh, and reading a book. Um, but when it gets exciting it's very exciting. You get to give people pretty cool drugs and watch them work in real time. You're kind of the person who, um, is seen as the person who comes to save the day when you get there, which is quite nice, but bit scary at times, you kind of do get used to it and you do get to use lots of cool gear. People think you're very clever, but really this is stuff anyone can learn, but we'll keep it a secret. We'll pretend that we're, we're super smart. Um, but really we just read the books that have the information in them, whereas the surgeons don't really worry about how the blood gas analyzer works. So I'd love to hear, uh, if you have any questions, I'd love to hear if there's anything else you would like us to cover sometime and I'll, that Palan, uh, come back in again. That's great. Thank you so much. Um, if anyone has any questions, far them into the chat box or if you prefer to speak, then we can invite you to be a speaker. Yeah. Do you, do you feel you can speak up if you want? That's absolutely fine. I would love a chat if this being recorded can be uploaded. Catch up session. Yes, it can. We're planning on having future events available on the page uh of the event on metal. It probably is useful to watch it. Like when you do get to interview to just have a wee refresher over the basic explanation of the curriculum, they'll not be looking you to go into like massive depth. Um what your opinion is on the curriculum because you won't know, you don't have an opinion, you just will have heard things. Um um And as long as you can sort of vaguely describe it though, they'll be happy with that, you'll get the tick in the box. Um So we have a question from Melinda saying, what can an F Y one or two due to be competitive? So in the past, it used to be, I would say do a TLS, do basic surgical skills, do a whole bunch of course, is realistically. Nowadays, you said the M S S is that the MSRA it's called? And that's um you basically just need to study for that in order to get the M S S A, is it? And then um there is an interview where they will ask you things. There's only a 15 minute interview online it's very, very quick and they will probably ask you things like, um, tell us about teaching you've done and they'll be looking to see how far down the line of teaching you've got as an example, teaching as an example. Say, so you might have a certificate or diploma, you probably won't at that stage, that's pretty normal. Um, or they might say, have you done, tell us what you understand about audit? So have you completed an audit cycle? You could talk about one that you've done. There is on the Royal College website. There are youtube videos, the Royal College of anything, this website there, youtube videos with mock interviews which I would advise you to watch. Um I'm, I honestly don't know if an FTA unless you're, you've done a whole lot of stuff. It's very hard to be competitive as an F two. You might need to take an extra years of trust grade to do something that stands out whether that is time abroad, extra teaching some research. Um It is really difficult to be competitive these days but definitely getting in through the door, you need to study for that exam for sure. Uh So we have a question is the M S are a not mainly for GP training. I think that I thought so used to be, it used to be on the questions are very much aimed at G G P knowledge, but my friend recently, she hasn't, she applied for E D and she sat the MSR I um the questions were all she was telling me she was like, it's all like childhood vaccination schedules and rashes and ent problems. Like it's very, very general and vague because they're not expecting you to sit an exam with specialist knowledge by anesthetics. That would be super unfair. And um so as far as I'm aware, that's the way it is particularly for. Yeah. And she applied to, to England and here and then is there another question? Do you have control over from? You applied? So with much control. No, not really in a way. Um So some of the specialist modules you can imagine I'm gonna stick with here about Northern Ireland. I can talk to you about England if you want but Northern Ireland, you can only do cardio thoracic at the Royal. That won't surprise you. They like you to do pediatrics at the Royal sick kids. They like you to do obstetrics at the Royal because that's where all the patient's with really odd comorbidities are sent. They like you to do um you have to do neurosurgery at the Royal cause Antrim like doesn't do neurosurgery but you could, you could easily be sent to Derry or Cray Gavin or Antrim or the Ulster. Now every year they do send an email like where they ask you what you've done and what do you want to do in the future? And if there is a specialty you're particularly interested in, say, pain medicine, then they will try and place you at the city or the ulster. If your specifically interested in cardiac, they'll have to place you at the Royal. Um, but you can't really say I don't want to go to Derry because I have kids. They just won't listen to that. So, not a lot of control, to be honest, which is a bit, um, a bit rubbish, but I think that's the same with every specialty. There's another question here. How did you find managing all the exams and studying? So, um, can I have a hands up as to any of you have kids? Can anyone put a comment if they have Children or you'll carefree and, uh, love and life at the moment? Okay. I've got no idea of kids. So I sought the primary with no Children. I set the final with Children and when I start the primary, I think the primary it was worth not having kids, uh, for which sounds awful. Like just do life the way you want to do it. I'm not going to tell you what way to do life because I, I sort of did it the wrong way technically, but I found it useful to be able to come home and sort of just be able to study. And I did like, I really loved doing what I did and I really wanted to learn how it all worked and So I, I just didn't mind coming home and studying and I was doing like an hour or so a night. Um And then that was just to learn how to do the job. And then for the primary, I kind of just set specific goals, like I will do 50 M C Q s today. And you can usually fit them in, in theater on, on, like doing them on an app with the vivat. You can like form sort of pair groups where you've, I've each other or you can get like a senior reg to divide the, you, they're usually quite happy to, to listen to you, especially if you hand them a vie the book with sample questions. There's a thing called Doctor Podcast, which is a whole series of podcast with like model answers as well, which I listened to sort of on my way into work on my way home from work that was useful. Um Then, and I, as I say, like in my day, they wanted you to set it all in ct one. But I, I wanted, I'd rather pass first time than, um, set the exam before I was ready. So I took a bit longer and that meant I was able to use more study leave to go on courses. So I went to Coventry and I went to the one in London, there's ones all over the place that you can go to. I'm Belfast, do a few as well for finals. I, I, at that point had a child but you kind of just learn how to manage it. Uh In fact, um anything you find a chore, know, I as a single childless person, like doing the dishwasher or walking the dog or like anything chore, like becomes a break from having Children when you have Children. And so me studying, I was able to go like, oh, I need to hide and study. So you're gonna have to look after the kids tonight to my husband and then I had this lovely child free time to study. So for me, finals was fine, studying for it was fine. Um because by then you know how to set an MCQ paper, you know how to do a five A, you just need to learn. Um It's more about learning a few papers and things like, for example, should I do a G A or a local anesthetic for this procedure? What does the evidence show? That's kind of what they want you to learn? And by then you're kind of wanting to know that stuff anyway, you're kind of learning it anyway because you will be asked in theater. So uh yeah, it's not easy. But then I think if you're, if you pick a specialty that you dislike just because you think it will be easier, you'll not enjoy studying for it. And so it won't be easy. But that, that's just my opinion does know that you can with work, help with the exams. Yes. I think in anaesthetics it is good the way they're kind of intertwined.