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Ok. I think we've got double figures now, even if we want to start and if people join late, they can always watch it back. Gnostic. Ok. Um Hello, everyone. Thanks so much for joining us tonight. My name is Charlotte. I'm um on the committee for the Northern Ireland Foundation, Doctor Society of IC and Anesthetics. Um We're a relatively new society started a couple of months ago. So, um this is our third event um intro into applying to anesthetics. Um and what it's like as a trainee. So thank you very much for um coming along. Um If you have any ideas or things that you'd like to see over the next couple of months in this year, please let us know um and put it in the feedback. Um We are putting together um more events as the year goes on tonight. We are kindly joined by Doctor Jason Nicoletti, um who is Act Two in um anesthetics. He did the A CCS training program. Um So he's gonna chat to us tonight mainly about applying anesthetics. Um this year, um tips for the interview exams. Um and just generally how he's find it as a trainee um and how he found applying as well. So I'm not saying too much more hand over to Jason. Um Last thing is just to say if you have any questions, please feel free to put them in the chat. Um, and we can answer them as we go along if Jason's happy enough or it can address them at the end, but I'll hand over to you now, Jason. Thank you very much. Uh Thank you very much, um Charlotte for that very nice introduction. Um Hello everyone. My name is Jason. Um I am currently an A CCS anesthetics trainee um Act Two in the royal working in a block theaters at the moment. Um The purpose of this talk, it's gonna be very um informal kind of conversational. Um I'm gonna talk you through my experience predominantly of the application process into anesthetics and A CCS anesthetics is a common pathway um for the application. Um I'm gonna chat you through um some of the difficulties, the hurdles, the time scale um and give you my spin uh on things. Um I'll pop my email address on here. So if you have any questions about anything that I've um alluded to during the talk, uh I'm happy for you to get in, in touch with me. Uh And also if you want to pop any of your uh questions or suggestions into the chat box, um I'm happy to take questions as we go or you can leave it until the end. We're gonna spend five or 10 minutes um having a look at the application process itself. Uh and then we'll spend about five or 10 minutes uh talking about the dreaded M sra. Um Then we'll talk a little bit on interview preparation and resources. And then finally, um on the end, at the end, we'll chat about core anesthetics versus A CCS, anesthetics, apologies. A lot of this talk is quite dry looking at the application process um should lighten up a little bit towards the end when we're talking about core and A CCS anesthetics. Um So do stay with me. So firstly, applications are closing very, very soon. Um For those of you that are applying this year, I know not everyone on here is applying this year. Um applications come around really, really quickly um really in the first few months of F two and they're closing in the mid to the end of November. I think it's the 24th of November. Um So if you are thinking about applying to anesthetics this year, um then you need to make sure that you get your application in ASAP the time scale. This is taken directly from the um A R website, the anesthetics National Recruitment Office. Um So you can see the advert for the jobs has already appeared. Applications uh are open on the oral website and it is the 23rd of November, sorry, where our applications close at 4 p.m. Um Very important that you don't leave it until the last minute in submitting your application because there's some very detailed information um that oral requires and you need to get referees and everything sorted. Um So don't leave it until the last minute. Aureo also has a habit of crashing um in the hours running up to the applications closing as everyone logs on, it can only handle so much traffic. So it's already a stressful enough process. You don't want to add any stress to that. So make sure that you have your oral application submitted in good time. This looks like a really long time until um April or March until the jobs come out. But actually, once you start the application process, this timeline absolutely flies in. Um and you'll have your job offers or not as the case may be um by the time the spring comes out. So it happens all very quickly. You can find this timeline on the anal website uh in the applicant guide. Um And that brings me on to some of the crucial resources for those of you who are considering applying this year. The applicant guide and the person specification are the two most important documents. The applicant guide takes you through the application process from start to finish and also talks you through the selection process. Uh And then the person specification, there's a person specification for every specialty, the anesthetics. One is very helpful. It takes you through some of the essential skills and desired skills and qualities um that the college is looking for in its new anesthetic recruits. So it will help you tailor your application and your interview technique uh and preparation. We'll chat a little bit more about that later, the N IDO website um since they have um updated their website now, um is much better than what it used to be. And they've got some good resources under the hospital specialty recruitment and links to the website. Um And then the Royal College of Anesthetists um have invaluable information on their right through from applications and also giving you an idea of what it's like um to be um a junior anesthetic trainee. So I would really advise that you um go through every document um and heading of the RCI website um before you uh approach your interviews, but all in good type, this is just a few screenshots from the Nimda website, having a look at the competition ratios in the last few years for lots of different specialties. I hope that's projecting um OK, uh unhelpfully for um anesthetics um they put national so it told us absolutely nothing about the 2022 intake, but if we go back one year further, um and this is the year that I applied. Um You can see anesthetic CT one A CCS. Um It's not that they didn't appoint anybody um in a CCS, anesthetics. This application process for anesthetics A CCS and CT one runs as one process and it's only later when you're ranking your jobs as to where you want to be, that you decide whether you want to do the A CCS or CT one program. So it is the same um application process, same M sra same interview. Um and then you ran whether you would like act one or an A CCS job. Um As you can see in 2021 um the number of applications um was approximately 80 they interviewed 39 deemed 37 appoint and then there was 19 jobs um that were given out um the barrier between the number of applications around 80 the number interviewed down to 39. So that's a 50% cut. There is down to the M SRA um exam that you will all at some stage have the pleasure of sitting even if you decide not to go into anesthetics. Many specialties are using that now. So it's really important. Last year, they used the M SRA a little less and interviewed more people. I don't know what the colleges plans are this year. Um But it's really important to have a strong M SRA score to maximize uh your chances of being successful getting to interview and then being successful. Um Just off note, um certainly in the year that I applied, um it's worth looking at some other specialties if you look at core surgery, lots of people say that core surgery is, is very competitive. Um, if you look at the number of applications, they had a lot of applications and they interviewed a lot of people. 100 and 15, um, 100 and nine of those, 100 and 15 people were appoint. And although they only had 37 jobs, the 108th person out of the 109 that were deemed appoint, um got offered a job and that comes down to the way core surgery is recruited, it's on a national basis. Whereas anesthetics is recruited on a regional basis for all of Northern Ireland. Uh And that means that if you select on your application that you are applying to Northern Ireland, then you cannot apply to Scotland, England or Wales. And similarly, if an English trainee, someone who's studying in England, um and is doing foundation in England and wants to do anesthetics in England. If they apply um for the England Scotland Wales application, then they cannot apply to the Northern Irish Anesthetics program, they're mutually exclusive. Um And I think that is probably um for the best, I think that works out likely in our favor. So this is just a quick screenshot of the ARO website. Um It's got vital information for all the CT one application, um documents and some national documents. Um and some advice on the uh interview formats, et cetera. Uh and you'll frequent that site um whenever you're applying because it's got lots of useful documents. So that's the application process bit out of the way. The next thing then we're gonna talk about is the M sra um It is the number one thing that is standing between you and getting that all important interview gone are the days of having self assessment criteria and portfolios and lots of procedures and things to get an aesthetic interview. Now, it is based on the multispecialty recruitment assessment. It is comprised of two sections, a clinical problem solving section which makes up 50% of the online paper and professional dilemmas which makes up the other 50% in the total score whenever they are deciding um on who to appoint for the jobs and anesthetics. 85% of your score comes from your interview score and 15% of your score comes from the M SRA and actually people's scores tend to be fairly close together for the M SRA. So it's almost negligible 7.5% attributed to clinical problem uh solving on 7.5% for pro professional dilemmas. So 85% is the interview. So the purpose of the M SRA is the shortness when you get the interview. Um it, it, it's function really, it, it's pretty, pretty much negligible on the impact that it has in terms of getting you appointed. Um a few practical and logistical uh tips for the M sra you book as soon as the emails come out, they invite you. Um It's on the timeline there at some time in December. Um, the invites come out on a certain date. Be ready, check your emails, check your junk emails, even a few days before, um, get in there and book a slot where you're not post nights where you don't have to drive from Belfast to Derry or Derry to Ballymena or that you're not traveling long distances they're held in the Pearson view um assessment centers. Um So get a convenient slot, get a convenient location. And actually, particularly during COVID Times, there was a lack of slots and you heard horror stories of people having to fly over to Scotland and England to be able to take the M SRA because the slots book out quickly. So make sure you get your slot nice and early in a location that is convenient to you in terms of the clinical problem solving aspect of the M SRA. The best advice that I can give you is practice questions, questions and more questions. And I know it's a little bit repetitive, but it all comes down to pattern recognition. This is not new concepts. The clinical problem solving is to the level of an F two. It predominantly involves most things that were tested um at finals. So the difficulty hasn't increased. The only thing is since finals um for a lot of you or certainly by the time you're applying, it may have been a few years ago and surprise you how quickly you forget lots of things. So I find the best questions to do were some of the online question banks for me. I used pass medicine because that's what I used for finals and it worked well for me. They have a dedicated M SRA section. There are other question banks available, but I find the past med ones the closest to the style of the M SRA exam. Um and I did very well on the M SRA. Um So I would, I would advocate using that. Um The one thing I would say is you can use your finals notes, but beware. Um even though it's only a couple of years since you've sat your finals for me, it was less than two years from when I'd sat my finals to when I applied. Um all the guidelines that I had printed out in my finals notes had changed. All of a sudden, it was a different first line antihypertensive or it was a different management of Menorrhagia. The nice guidelines have changed. It's a different heart failure medication, that's first line. Um So all of those things um change rapidly. So you need to make sure that you're working off the latest guidelines. There is a really helpful past uh sample paper on um the health education England M SRA page. I'll put a link to it here. This is the closest that you can get to the style of the paper. Um It's very helpful. The most important thing about doing that paper is not doing the questions, but rather reading all of the rationales and understanding why they're asking the questions that they're asking. The MRI didn't find to be a particularly time sensitive exam. I think I walked out with something like 40 minutes left, um, on the clock, but it probably is helpful to time yourself just to give you an idea. Um I would time yourself the first time you sit that online paper. Um rather than after you've done it 10 times and can recite all the questions, it'll give you a more accurate idea of what the timing is gonna be like in the exam in terms of the professional dilemmas. Um Half of the M sra um the questions come in two different categories. There's the ranking questions, the multiple choice questions I would approach these similarly to how you approached your SAT questions. Um Firstly, by identifying the theme of what they're asking and we'll have a look at some of those themes in a minute. One of the biggest things that makes the M sra professional dilemmas a little bit different from your SS at is that you're not answering the level of the question as to what an F two would do rather than what a medical student would do. And that leads to some subtle differences. So it's important that if you're doing some practice questions for the professional dilemmas that you're not doing S JT questions for medical schools, you're not doing SJ T questions that are for registrars or for consultants, you should be doing professional dilemmas. ST questions at the level of an F two because that will change the answer. Um The practice papers are your most valuable resource for this. Um read the rationales again and again and again, um and understand the order and the the options that they have selected. Um fully, that's the best advice that I can give you for that. The question, bikes are not as good online for the professional dilemma questions. I find the past test ones to be slightly higher quality for the professional dilemmas compared to the other question bikes, there's only so much preparation you can do for the professional dilemmas. Um By far in a way you can focus uh and increase your ability in the clinical problem solving skills with lots of study, you can still increase your score in the professional dilemmas. Um But it's just a little bit harder to do so and you probably don't need to allocate the same amount of time or certainly, I didn't. There's a really helpful um blueprint document um that you can access for the M SRA. It's on the Andre website under the M SRA heading. If you click on that and or you can just Google um M SRA blueprint or you can copy in the link that I've um copied into the bottom of the slide and it takes you to this page again, I don't know how well that's projecting. Um But you can see that there's three domains, professional integrity, coping with pressure and empathy and sensitivity. And then there are different subunits between those. So for example, um willing to admit to when experiencing difficulties and seeks assistance where needed if you have a read through those, um it actually becomes quite easy once you read the M sra professional dilemma, questions to figure out which one of those are testing. So once you've identified the, the um then it really helps you um decide the ranking order of the four options. There will always be a very clear first option uh and a very clear last option. It's always the two in between. That's the most difficult for the multiple choice ones where you need to select three options. The easiest way I find to approach those is to make sure that you choose three options that deal with three different aspects of the question that deal with each problem. The question has presented, don't choose two options that deal with the same thing cause it's not likely to be correct. Similar to whenever you did your practice for your S JT. Similarly for the clinical problem solving um section, there are 12 clinical topics um which are assessed. This is helpful because it gives you an idea in your revision as to how much time you want to set aside for each of these topics. So if somebody is particularly smart or savvy or some people might say Lizzy, if you're coming up to the exam and you haven't done very much preparation, you've got a limited amount of time and let's face it. We all have a limited amount of time. You could say, well, I'm gonna really focus on cardiovascular and respiratory um and peds um because they, they are each of the one of the 12 areas and they equally test all 12 areas and I'm not gonna pay just as much attention to hematology. Not because I don't understand anything about hematology. Nobody understands very much about hematology but that it's one out of four different specialties in one clinical area. So you're gonna have less hematology questions than you are respiratory questions. Um So that's something just to bear in mind to help you time. Uh your revision. Um One thing um I will say about that is just be smart about your revision and um make sure you do as many questions. Um as possible. There are different domains that they test. There are five different domains. I don't have them on the slide here. One of them is something like diagnosis. Uh One of them is pharmacological management, but there's 1/5 domain um called non pharmacological um management. And um these are the questions that I find most difficult in the M SRA. Um These are things that might concern the dietary management or exercise management or social prescribing management um of some of these different things. Um So it's certainly worth having a look into nonp prescribing um uh therapies and things that can be that are non non pharmacological management of different conditions because that's actually quite a large subsection of what they test. Um If you go on to the M SRA um website or follow the link through the ARO website, um you can go into a document and it gives you the full breakdown, the full blueprint of the M SRA and all of the sections. So you'll be able to see a little bit more about what I'm talking about there. Um Each section, the clinical professional, the clinical problem solving um is the mark is converted to uh a normal distribution around a mean of 250. And the professional dilemmas um is the same, it's uh made into a normal distribution with a mean of 250 with a standard deviation um of 40. So that means um 68% of people will get a score between 2, 10 and 290. Um and then double that up was at 4 2500 and mm 540. No, I can't do maths. Um But with all the pressure of everyone watching me, but um it means that most of you will have a score that's in and around 500. Um You're gonna get your M SRA score. The first thing you're gonna do is go on to social media, whatsapp groups, reddit, um all of these different um websites and you're gonna compare your score with other people. The one thing that I will say is even though the average is 250 plus 250 which is 500 anesthetists and future anesthetists are in their very nature, very good exam takers. Um which ultimately means that the cutoff for interview is not likely to be anywhere near 500. In fact, it's likely to be much higher. So whilst 500 might get you into uh a specialty, um a less competitive specialty, it may not get you into, get an interview for anesthetics. Um You're actually competing with each other and with the very people that are on this um her attending this presentation tonight. Um because ultimately, if they're using this again as the way of shortlisting people for interview, um if there are about 80 applicants and 40 interviews uh as there were in my year, um then the only M sra score that concerns you is one that is better um than the average or the top 50% um of anesthetic applicants in Northern Ireland. So if you all in this call go away and study really hard and you make the, the top 50% of you are getting 580 above, then that's where the cut score may be for the interview. Um So it is difficult. Um It is a difficult exam. Um Not because the uh the knowledge that is required to do it is difficult because the professional dilemmas is difficult and because the score to get the interview can be astonishingly high. Um because um future anesthetic trainees are very good at exams and aesthetics is some of the highest M sra averages according to other specialties. OK. Congratulations. You have passed the M SRA. You have got a score that has earned you an interview well done. Now, all that's standing between your job and anesthetics as Act One is the interview and the college have confirmed that the interviews again this year will be done online um through, I can't remember which platform if it's Zoom or Microsoft teams, but they will be online and there's some very helpful things that you can do to prepare for your interview. The interview is broken down into two sections. The first half is a clinical interview station lasts for approximately 15 minutes though not always. If you cover all the points, it may be shorter. I think mine um was just under 10 minutes. And then the general interview station which you again on average is approximately 15 minutes and they are weighted equally. The clinical interview stations tend to feature uh an ABCD E Acute Management of an unwell or deteriorating patient. What's really important to remember is that some of you on this call may be very senior. There have been uh very senior applicants in lots of different specialties, medicine and ed who, who come to anesthetics uh a little bit later um along their training pathway, um those people have very, you know, have a wealth of knowledge and experience. But for the purposes of the interview, you should be managing these cases to the level of an F two. So even if you've done four years as a clinical fellow and worked on a red road, um you're being assessed as working at the level of an F two for the clinical interview station. And that has implications in terms of seeking help early and managing the patients appropriate to your level. And that may not, that may mean that you're not the person who's taking the patient definitively to get definitively managed with their laparotomy or tracheostomy or whatever it happens to be. So you manage them to the level of an F two. Um Again, from the Andrew website, there's a few important things that I have highlighted on here. Um The first and most important thing is um in previous years, they have published the scoring metrics before the interview um before the interviews commence and you can see which domains you're being assessed on and how many points are being assigned per domain within the clinical interview station. They tell you that they're assessing you on your clinical judgment, decision, making your team working and working under pressure each with five points per interview, bring in a total to 30 marks and then an interview gives you a global score of up to 10 marks each bringing your total clinical interview station up to a total of 50. And then for the general interview station, the domains that they assess are communication and professional behavior, commitment, specialty and reflective practice. Again, they all have equal winnings, five up to five per interviewer per domain and in a global score each of 10 for the general interview station, it's important to say um that the scoring matrices differ from year to year. So if you're not applying this year, then these slides will be out of date and they may have changed by the next application cycle. This is the legacy scoring matrix whenever um uh for the people who were applying last year. Um And this is lovely because they've given you the mark scheme. So you're able to go through each of the attributes or domains and make sure that you're maxing uh your um your points uh in each section um at the time of recording this um whenever I was preparing slides um a few days ago, they didn't have the scoring matrix for CT one this year, but I just checked last night and thankfully, they have now um updated the matrix and this will be the mark scheme for your interviews. Should you get one again? All of this is on the ARO website, it's got some really good resources. Um And this really is your cheat sheet to the interview. It shows you all of the domains that are going to be assessing and you should aim to max out um as many of these attributes as you possibly can. It also means that you know what to Sprinkle into your answers to make sure that you're hitting a maximum uh in each of those domains. Um Something like professional behavior on communication or reflective practice might sound a little bit vague. You can see whether they're assessing it in the clinical interview station or the general interview station. So, for example, under reflective practice assessed in the general interview station station number two and reflective practice might be something along the lines of tell me a time when Xy and Z happened to you or tell me a time when something else happened to you. Um I've broken down one of these sections uh into a little bit more detail. So the commitment to specialty section in which there are five point for each interviewer to uh assigned to you. Um If you go to the person specification, that's the document that I was talking about at the beginning of the application um process on the ARO website, breaks down all the attributes that they're looking for. And here you can see the essential criteria and the desirable criteria and where it is assessed and note that it is assessed at interview here um on the right side of the screen. So some of the essential criteria showing initiative drive enthusiasm, demonstrable interest in and understanding of the specialty, commitment to personal and professional development, evidence of self-reactive practice, extracurricular activities or achievements relevant to the specialty. So most of that is self explanatory. Um They're looking for somebody who's shown the initiative drive or enthusiasm who perhaps um have gone and organized um uh taste or week in ICU or anesthetics that covers the fact that you have got that self drive and enthusiasm and also that you've demonstrated an interest in specialty, maybe you've organized to go on a course um that is relevant to anesthetics. That would certainly be a commitment to a personal and professional development. Um So those are some of the ways um that you can meet each of those points and criteria um for each of the domains that are assessed to interview. So, rather than working really, really hard and getting nowhere and feeling that you're at a complete loss and preparing for the interview, use all these brilliant resources um use them to your advantage place, mark, know what's on the Mark scheme and what's on the person's specification. Um And you'll increase the chances that you can get your foot in the door to the best specialty ever. Um The I se medical books, not this one, this one's for medical school interviews that I've put here. Uh, disclaimer, I do not have shares in uh I se medical um company, but they do a great range of books and one of them, er, lends itself to core training and ST level training um in lots of different medical specialties. Uh It is by far and away, the most extensive resource that I used gives you excellent structure to each of your interviewed answers. Um And really helps um give you the confidence in the practice that you need to be able to get through the interview. And it's brilliant, it gives you lots of examples. Um And it gives you examples of questions and an example or answers that you can model your own answers on. And it's really good at making you reflect on all the different experiences that you have had as a trainee that you can bring to the interview and make yourself stand out remember to be reflective during your interviews and to make sure that you're telling lots of personal stories or things that have happened to you and what you have learned from them to maximize your reflective uh marks, but also to make you stand out from the crowd and make the interviewers remind you. And on that note, it is important before an interviewer gets to know you that you get to know yourself. Uh And what I mean by that is you need to sit down with a pen and paper. And this book is very helpful and think, OK, when was the time when I demonstrated leadership? When was the time that I demonstrated good communication skills? When is the time where I was a good team player? And you can have a few of those instances in your head uh ready to rule out for interview questions. You might even use some of the same scenarios for different questions and put a slightly different emphasis or slant on them. Uh And this is a really good way to make you stand out in the crowd and um make you excel in your reflective practice. These are just uh a bit of a random workload. Um These are some of the things that come to my mind as hot topics in anesthesia at the moment. Uh anesthetic, non technical skills A N TSI should read. Um of which situational awareness is part of that, the non technical skills are not things like intubations and ventilations in central lines, but rather your teamwork, your leadership skills, your situational awareness, um your empathy. Uh those are all very um hot topics and anesthetics at the moment are important things to get experience in and think of times that you have used your own um non technical skills in your clinical practice. And there's some really good uh papers uh to have a look at. Um there's some links through the RCO A website. Um, and the Association of Anesthetists as well have great documents on anesthetic, non technical skills. A S and T, um, the new curriculum, I shouldn't really call it a new curriculum. It's the 2021 curriculum, uh, for anesthetics. You should have some idea of what the, uh, curriculum entails. Why the curriculum has changed from the old curriculum to the new curriculum should have an idea of what is meant by a critical incident. And I think it would be good to have a read through the National audit projects. Uh nap 12345, looking at things like um airway um e emergencies and management and um you know, you know, interoperative uh awareness under anesthesia. Um those are large national scale projects that look at um one area in anesthesia provide recommendations each year. I think it would be fair play to ask you about those perioperative medicine is a rapidly expanding field in anesthesia. Looking at the anesthetist, not just as the technician um who looks after patients um during anesthesia, but expands the role of the anesthetist to the perioperative physician, looking after patients preoperatively pre assessing them, um optimizing them pre having them um and rehabbing them and finding an appropriate um postoperative destination for those patients. So that's something that's a real hot topic um in anesthesia at the moment. And you should have an idea what is involved in perioperative medicine. And lots of you will have experience working in perioperative medicine when you have done your surgical F one and F two jobs um where you have been working on the vascular or general surgery wards or thoracic wards and you've been managing those patients perioperatively um and optimizing them for their surgery and helping them to recover. Um So lots of you will have excellent experience of perioperative medicine working in the Ortho Gerry, for example, in the Royal is another excellent example of Perioperative medicine and action. And it would be very good to talk about during your interview. I'm sure uh regional anesthesia as well. Um Another rapidly expanding and growing field uh within anesthesia and lots of subspecialists, particularly in Northern Ireland and regional anesthesia would be a good idea to have um some sort of a notion about what's involved in regional anesthesia and the benefits of the patient. I think those would be some of the big hot topics that would jump out at me that somebody might perhaps ask you about or even better. You might volunteer during the interview. A quick word on the curriculum. I'm aware we're running out of time. So I'll speed up a little bit. Um The curriculum, uh The new curriculum is based into three stages, stage 12 and three during stage one. It's your CT one year, ct two year, ct three year. And if your A CCS that will include your CT four year uh during this period of time within the first six months, you should obtain your initial assessment of competence. I ac your initial assessment of competence is what you need to be signed off before you're allowed to fly solo as an anesthetist. Now, it doesn't mean you're going to be doing solo lists working on your own. No supervision. Ever. Not at all. But it means that's the point after you've got that signed off that you can be left alone and a list or a consultant can step out for lunch. For example, that means that you need to be able to uh manage patients. You need to be able to preassess patients and you need to be able to manage them intraoperatively. It's made up of basic airway skills, uh video, laryngoscopy, bag, mask, ventilation, um uh direct laryngoscopy, endotracheal intubation, spontaneous uh ventilation, intermittent positive pressure ventilation, um and handover to recovery staff. Um that takes about six months to obtain. I'm currently working on mine at the moment. Um It's quite stressful. You need lots of work based placed assessments, there's no number that you need. Um But you can be expecting. Um you know, II think I've got 30 work based placed assessments and I'm only three months in and I'm probably only halfway there. So you need to be uh you need to work really hard to get your initial assessment of competence. Um The initial assessments of obstetric competence then that comes after that, that is in your CT two year. And that's with regards to obstetric anesthesia. By the end of stage one, that's the end of your CT three year. Or if you do a CCS your CT four year, you must have completed the primary F RCA. Stage two is made up of ST four and five. And by the end of stage two, you must have obtained your final F RCA exam and stage three, ST six and ST seven allows you to do fellowship years areas in particular uh specialist interest areas that um you might like to practice in, in the future to get extra experience. Uh And at the end of that, then you can apply for your CCT, your certificate of completion of training, a quick word on why. Um the curriculum change. There's a brilliant podcast on the RCA website under the new curriculum. Um You can listen to that last for about an hour, but it goes through the reasons why they changed the curriculum. And one of the big ones is core trainees were not getting their exams on time by the end of their CT two years. So they've added an additional year and that brings me on to uh the dreaded um anesthetic exams that you will need to pass by the relevant stages. The primary F RCA uh which is made up of three sections of multiple choice paper, a structure structured oral examination, otherwise known as the Vida and an OSC and similarly, your final F RCA consists of a continuous response question, written paper as well as another viva and another OSK. So you've got six different components of exams to sit. Um, that need to be completed by their, um by stage one and by stage two respectively. Um The primary F RCA, it's a really tough exam. Um, it's not clinical in the slightest, it's called a third um of physics measurement and equipment. a third of physiology and a third of pharmacology. Um so very, very challenging exams and um I'm sure you'll all have, you'll all be looking forward to doing your exams once you get the sack. But there's a little bit more time and a little bit more support in doing these exams now than what there may have been historically. And that's just a little bit in terms of the interested professional activities. One and two that make up your initial assessment of confidence that should be obtained by the first six months uh in your anesthetic placement. Finally, in the interview, there's the global score. The global score is um I think the best way I would sum up the global score. Um And this is something a consultant that he said has told me before my interview. Um it's the interviewer's overall uh impression of your performance in um the clinical section and in the um the general interview section, uh the consultant has told me that at the end of the day. Um the person on the other side of the interview board um wants someone that they can sit and have coffee with because believe me, um and he does love coffee and you will spend many, many, many hours um sitting beside a consultant beside an anesthetic machine and you will be making lots and lots of small talk. Um And you'll have many a cup of coffee once a very long um fractures case or laparotomy case is, is ongoing. So when they're interviewing someone, they want someone that they can sit and make small talk and have a chat with and be personable with, um, who's going to join them on their lists. So that's, that's aspect. Number one, the other aspect is they also want someone who is prepared to hit the ground running and be that person who can respond in absolutely terrifying emergency situations. They want someone that they can count on who's gonna be safe and competent whenever like this, your BP is 47/28. Um And your entitled CO2 is falling or, um, hopefully you won't have to deal with the sit situation, but you need to go for emergency front of neck access, uh as a surgical airway um emergency. Uh They want someone that they can rely on who's clinically signed and able to deal with pressure and they're looking for a balance of those two things. Uh some other helpful interview resources. Uh There's a podcast on the ra website, not pod uh the novice guide, which is very good to read, to give you an idea about what's involved uh as an anesthetic trainee, uh and review the curriculum documents and so forth. Um So the journey, um, I'm gonna chat now in the last five minutes or so about my journey through a CCS anesthetics rather than core anesthetics. This is the A CCS training pathway. Um, contrary to popular belief, uh whenever you choose a CCS anesthetics, um that means that you will be an anesthetist, it doesn't mean that you're gonna go, you have the option of going and becoming an ed physician or becoming a medic. Uh You're on the anesthetics training pathway from the beginning and you're treated like an anesthetics trainee, you've got an anesthetics uh educational supervisor, but instead of going straight into Coron anesthetics, you do an extra year, the CT one year and during your CT one year, you will rotate through six months of emergency medicine and six months of acute medicine. And currently in northern Ireland, all A CCS anesthetic trainees in the last few years have done six months of respiratory medicine in Antrim and six months of training in the royal. At the end of the two years, you get your A CCS training competency, signed off and then you join uh your core training colleagues um for your CT four year or your core training colleagues. CT three. Um and other than that, there is essentially no difference between A CCS anesthetics and anesthetics. Other than that first extra year where you do the six months of Ed and six months of medicine. The other difference, there's one other difference uh which is during your A C CSC T two year. When you do six months of anesthetics, you will then do a full six months of intensive care. Your core training, colleagues will do nine months of anesthetics in their first core training year. And we only do three months of um ICU uh in their CT one year. However, by the end of the next year, that equals out because in their CT two year, they do another three months of ICU. Whereas with the A CCS training in your then CT three year, you don't do any ICU. So it all equals like by the end. So my experience uh as an A CCS anesthetics trainee. Um My time in Antrim was my first six months. There were lots of positive things. I got lots of chest drains, pleural procedures. Um Thoracic ultrasound, I also did lots of clinics um which was ok to get that. Some people like clinics more than others. I wasn't a big fan uh because it wasn't very acute but lots of people um uh enjoy the clinics. Um You hold the admissions to bleep ru uh plus plus plus you're on the medical take um which is pretty relentless in Antrim but you get really good really quickly at dealing with really sick patients. Um So I gained a lot of experience uh in that job in those six months. Um I also had the chance to work on the consultants there on a project uh on thoracic ultrasound. Uh looking at diaphragmatic paralysis in patients, which is related to ICU and anesthetics and got an international poster presentation on that. So there's lots of things um that were beneficial for that placement for me. And then I did my emergency medicine placement in the royal um in uh a very busy ed department there. And what I will say about that is being on the training route in that job. Um Whilst there were some wonderful uh experiences in terms of getting involved in trauma calls and leading cardiac arrest calls and red recess tended to be in a big red recess about once a week. The rest of your shifts tended to be in majors um or ambulatory, which has got a little bit of a different pace to it. Um And the rota is tough. Uh You work lots of out of hour shifts and um you're working essentially every other weekend. Um And sometimes that's a little bit difficult whenever there are lots of local colleagues who could be earning twice the amount that you are for doing half the number of hours that you are because you're on a training roto. Um So that can be a little bit difficult, but for me, uh, it was a good experience. I got lots of procedures, nerve blocks, sedation, doing arterial lines. And, um, I think for me it was the right decision. Um, but I was very happy after I finished my CT one year. Um, and I have now since August moved into the wonderful world, um, of anesthetics, which is infinitely better to give you an idea of the day in the life of an anesthetics. Um CT one co trainee or anesthetics A C CSC T two. Me, um I've just taken a snapshot out of my, um, logbook to give you an idea of the sorts of things that you would be involved in. Um, I was off with COVID between the 11th and 20th of October if you're wondering what that gap is. Um But you can see there are lots of interesting cases um that I've been involved in doing general anesthetics and et tubes in the neurointerventional Suite. Uh doing sick laparotomies, transfers up to the CT scanner, uh vascular cases, trauma laparotomies, um Ed reco calls, um, doing rapid sequence inductions, um in Red Rus and Ed, um, and attending trauma calls, um, and also doing some nice elective, um, ent and orthopedics work and, um, doing some, um, uh, n lists and getting experience with doing spinals and um, femoral nerve blocks and sedation and things. So you say it's highly varied from what you're doing from one day to the next. And of course, there's lots of coffee, there wouldn't be anesthetics without coffee. So for me, um I find that the more general experience of A CCS anesthetics was helpful because I went straight in to training from F two. Um and that was helpful to give me a bit more of a grounding in trauma and ed in general medicine. However, it also means that I'm going to be there forever sho as I end up as an A C CSC T four trainee eventually. Uh So that's four years of working at sho level, which I think is one of the longest out of all the specialties that I can think of. I could have made lots more money if I looked an ED for the year round of the A CCS training. Um But that's the decision that I made. It also delayed the exams for me for a year. Um which was helpful. Um Because as I say, I finished after I was pretty tired and I didn't want to go straight into proper anesthetics and having the the exams looming very quickly. The additional year that you do counts for your ST four applications for anesthetics or ICU. You get extra points for your self assessment criteria at that stage in a training program. Uh And it also counts for ICU time. If I decide to do a train with ICU, my year of medicine will be counted and I won't have to go and redo a year of medicine, read there are only four posts and uh either they're really competitive because everyone wants them or no one wants them and they're not competitive at all. It doesn't seem to be anywhere in between. Um, just a word of warning. It is an extra year which means at least a total of eight years before you get your anesthetic CCT plus or minus six months extra. If you want to do with ICU plus or minus uh parental leave plus or minus if you decide to be less than full time. So if you don't wanna add uh any extra time and you want to get on with it, then maybe co would be better. Um But ultimately, you need to do what's right for you and everyone is different. This is what was right for me. Um But what's right for you might be a little bit different. My closing arguments then finally submit your application sooner rather than later check it, double check it, triple check it, make sure that all of the dates and everything on your oral application are correct. Start your M SRA preparation. Now get the ball rolling, check your emails, um book your M sra slot early, start your interview, prep early and practice and practice and practice um with your friends and your colleagues um and your significant others, the applicant guide and the person specification are your friend and choose a CCS um or co and anesthetics, whichever is right for you. And as always, I'm happy to help you can get in touch with me. Uh My email address is on the screen or um any of you can come to the stage and ask me questions now or pop your questions into the um message service at the side of the screen. Thanks very much. Thanks so much, Jason. That was so helpful. Um Does anyone have any questions as Jason says, if you wanna put it in the chat or um we can unmute you? I suppose I have a question, Jason just wondering see for teaching in anesthetics. Is it mostly just on the job possible teaching her? How does it work? Anesthetics? In my opinion, has one of the best. Um It, it's one of the best supported training environments and there's lots of teaching. Um So firstly, there's the on the job teaching. So you're with a consultant essentially 24 7. Um Or certainly all of your nr s are you'll be assigned to a list that as a consultant. So there's lots of one on one informal teaching. There's also lots of um fairly mandatory e-learning as well that you need to go through. Um So whenever there's a little bit of downtime between the lists, um it's important to complete all your e-learning modules as well. Um And then there's the F RCA study days. Um So there's F RCA Primary study days um of which there's must be somewhere between five and 10 of them a year. Um where you meet up with all of your colleagues around the province and you have presentations and talks on lots of the different exam topics. Then we also have our site wide teaching. So every month, um we have a half day which is allocated to um teaching in one of the anesthetic specialties. So today with site wide teaching on trauma anesthetics, so that was a full um afternoon um of trauma teaching, there's simulation teaching as well, which happens regularly and then there's departmental teaching um which also happens on a weekly basis, generally for about a half hour on topics in most places. Um And in addition to all of that, um there's also a mentoring program which is set up so you can meet with a mentor very regularly um to see how you're getting on. Um There's also lots of RCO A um tutorials. There's so much teaching that couldn't possibly mention all of it. Um And so you'll find actually a lot of your time. Um You, you'll be attending lots of formal teaching and that's in comparison to some other specialties, maybe or specialty areas in Northern Ireland where it's not very particularly supported compared to anesthetics. I think we're really, really fortunate with that. No, that sounds a lot of teaching, which is great. Um Fantastic. Thank you so much. Um I don't see any questions in the chat? Let me see. No. Um So I will let you go. Um Thank you again, Jason and his email address is kindly just at the bottom there if anyone does have any questions, um you can also send us a message um on uh we're on Instagram and Twitter and there is an email address on our page as well um for any questions. Um But thank you everyone for attending tonight and if you just want to fill out the feedback form after, um we would all really appreciate that um and hopefully see you at our next event. But thank you very much, Jason and thank you for everyone for coming tonight. Thanks very much. Have a nice evening, everyone. Thank you. Bye Jason.