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Right. Hi. So just this test before we can start, I can anyone who can hear me? You can see this. Could you just put in the chart? That would be great. Yep, audio and video. Great. Fantastic. So welcome one, welcome all to another webinar brought to you by BSA, the British International Medical Student Alliance. Um Our goal here is to create a more connected community for international students in Bulgaria, which makes it easier to help and support as we transition back to the UK and to our, you know, respective parts of the UK as well. Uh We provide resources for academic success for cultural integration and personal growth too as well as helping students adapt to the culture and education system back home. So my name's Nichelle, I'm 1/6 year internship er medical student er slash do currently in my state exams. Um and I have the pleasure of er introducing some very exciting speakers today. Er We have Doctor Aon and he will be introducing the talk on breaking the bottleneck, which has been very highly anticipated. Um er but before we start, I would like to kindly hand over to Sarah from the Medical Defense Union to say a few words. Lovely. Thank you. Well, good afternoon, everyone. I hope everyone's doing well and thank you for having me doing amazing work here. Very grateful to be involved. So my name is Sarah, I'm from the Medical Defense Union. Um and just to give you, just give you a bit of background about what we do and what kind of support we provide doctors. I'm just gonna be speaking for about 10 or 15 minutes and there'll be time for questions at the end. If you want to put any questions in the chat as well, or if you want to speak them out loud at the end, I'll be able to answer both of those. That's no problem. So, yes. So, Medical Defense Union, we are a defense organization. There are three main defense organizations in the UK, we are one of them. Um, and so, but what do defense organizations do? So we offer doctors and dentists, um, something called indemnity, which is really simply is just your legal support. So any time you think as a doctor, you think? Oh, I would really love some legal advice on this particular topic or you think? Oh, I'm scared, I'm going to get in trouble and I need a lawyer. That's what the scary side of it on that aspect. That's what we do. And we've been doing this for a long time. So, uh yes, so we provide indemnity for you for medical, both medical students and also doctors. It's an ongoing service so we can help look after you from the very second you start work, not even until you retire even further on than that, there's no necessary endpoint for it. And it's also, it's things about mostly for doctors um supporting you if you've had a claim made against you, if someone's tried to see you or if there's been a complaint against you or in the more serious aspect, if you are under any sort of investigation, whether that's within the hospital or whether that's a, a full on GMC investigation. So that's what we do. That's when we'd send our specialist lawyers out to help you. Uh NY PS. So yeah, that's just a little note from us as well. So we offer members expert guidance, personal support and robust even in addressing medical legal issues, complaints and claims. So just a little bit about the MD in our history. So like I said, there are three main defense organizations in the country. We are not only the U K's largest with over 200,000 members, but we're also the world's first. So we were founded back in 1885 with the case of Dr David Bradley. And it's quite an interesting one because he was treating a, he was a male doctor treating a female patient when she went unconscious. So he loosened the clothing around her neck, went away to go get help. He was the only person there on the scene. And whilst she was away, she woke up, saw the change in her clothing and jumped to the wrong assumption in this case that she had been wrongfully assaulted. There was no such thing as a defense for this. There was no legal team for doctors back in this stage. So after he was accused, he was simply sent straight to jail because of this. And there was his, his fellow doctors that realized the issue here, they knew he hadn't done this and they realized that he should have been able to have a fair trial to plead his case and everything. But there was no money. So they all pulled their money together, all throw in a few Shillings each as it would have been at the time to create, to buy a lawyer for him to create this defense, which is then what got him out of jail. And that's how the MD was started. And I know you see DD on the screen there. So MDU is the medical and then we also do the same thing for the dentist, which is the specialist DD, which came a few decades later, but that's how we're started. So we're very much a doctors, doctors organization. Our CEO is a doctor. We're run by doctors who know exactly what it's like to be in your shoes. Know all the stresses can relate can empathize which we think is really, really important for you. Um And yeah, so our job is to look after your reputation, look after your health and wellbeing from the stress and actual employment side of things. And we do this by so wearing a non for profit, meaning all the money the doctors put in as their membership, that is the money that gets funded around and gets used to then support doctors. And the amount a doctor pays depends on a multitude of factors. So an f one doctor isn't going to be paying the same as a consultant. So it's all based on what's going to be fair and how much you're going to use our resources. Just a little bit of thing about. Yeah, just a bit about that. So, yeah, perfect. Thank you. Um So we have, when you have, when your members, when you are a member with us, you have access to a fantastic 24 7 hour medical legal advice line, which is completely run by doctors um who are also legally qualified. And this is like I say 24 7, they get between 20 to 30,000 calls every year, 99% of which they answer within 20 seconds, which is a huge uh lifeline for doctors and it can be anything, it can be anything from you actually working in the hospital and there's a 15 year old patient and they're not too sure if they qualify for g competence or if they do the formality. You have to go about this or on your way home, we have situations where someone's biked home from work and they've lost some data, they've lost some forms. Whatever it might be anything, you worry, you're not too sure about the formalities or you worry you're going to get in trouble or you're working with someone and you're worried they're going to get in trouble and you need to make sure you keep yourself safe, whatever it might be, there's no judgment on this. It's an avi sign for you to use to hopefully prevent you from having to deal with any sort of more serious situation down the line. Um, and we're the only defense organization in the UK, with not all of our lawyers are in house, we also have a specialist team of criminal lawyers if you have been accused of anything criminal, which I'm sure hopefully, you know, at an opening of careers you ever do. But if you were found in that situation, we also have specialists to help you out there as well. Next slide, please. So the most common questions we get asked from people the first is going to be, why do I need indemnity? Why is indemnity so important? Er, very simply put, I'm sure you know a lot about the GMC and you obviously have to be regis registered with the GMC before you start work. It is a GMC requirement that all doctors have adequate indemnity for the work they do before they start work. And the reason for this is you a, a patient can't be advantage because you didn't have the finances to be able to fill in their claim. Should they need to say somebody at the hands of the doctor for whatever reason, whether it was clinically correct what the doctor was doing was right. But that person can't go back to work for a little bit or they lose their job for a little bit because for whatever whatever reason it might be, there can also be different complications that happen or just based on certain factors, someone may not be able to go back to work or they financially lost out whatever it might be. Um I can only rethink of a, a good dental, a, a good dentist example, but say somebody had a certain shift that evening, they were going to go to work and they were going to get paid 50 lbs for that shift. But the dentist accidentally takes her out the wrong tooth and then they have to stay later to fix this or to take out the other tooth and they miss that shift. They've been lost out on that 50 lbs. So they have to have that reimbursed somehow because it obviously they have been left without. So that sort of example is why it's so important that every doctor has indemnity so that the patient isn't, isn't disadvantaged. The GMC very much like the NHS are there for the patient, more so than for the actual members of staff. So that's the reason it's so important. And then do I need to be a member of a defense organization if I'm working for the NHS? So you might be working for the NHS your entire career, you may dip in and out, especially if you do foundation training with a um an official foundation scheme. At that point, you definitely will be working for the NHS any time in your career, you are working for the NHS, they will give you their own version of indemnity. You may hear it called trust state or crown indemnity. That's all the same thing. That's NHS indemnity, er, in the eyes of the GMC. This is a tick. You do have that proof of indemnity which allows you to hit that qualification with them and be able to start work. But um next slide please, it doesn't actually go very far in regards to a doctor's benefit. Unfortunately, because it just doesn't have the funds. The NHS don't have the funds to both look after you at your hospital and all the patients and then look after the legal side of the staff as well. The most important cases we find are if you are under any sort of investigation, whether in house or with the GMC, if you are asked to attend a coroner's inquest or write a coroner's report, um, these are situations where the NHS indemnity is not going to cover you. They're not going to be able to help you. Or the most important one, we find the most common one is Good Samaritan Act, which if you don't know much about Good Samaritan Act, um it's effectively where you're not on shift. You, you might be out and about on a Saturday going for a walk and there's a medical emergency, you know, is there a doctor in the house or you on a plane? Is there a doctor on board? And you do go over to help in that moment, the person we're helping is your patient. They do have the legal right to make a complaint or a claim against you if they wish. Um NHS indemnity would not cover you here at all. Whereas being with a defense organization, being with the MDU, we do, we look after all our members 24 7 for no matter what you're doing. Um including Good Samaritan Act. And we've actually, despite the how many claims and complaints we have had from people through Good Samaritan Act, we have not once had a successful claim or complaint against one of our members for this, which I think just shows how, how important it is as well. Next slide please. We also, if anyone is interested in statistics, we do have a fantastic track record and we look in regards to looking after our members um as you can see a bunch here. So like I say, you've got that amazing advice line where I think 2020 those 21,000 calls, I think in last year, there were even more calls and like I say, there are within the 1st 20 seconds, we also have a really useful membership, um advice line which again, follow 80 ton of calls made to me are answered within 20 seconds as well. And we've had cases where doctors are scrubbed up, perhaps has a nurse holding their phone to their ear checking, calling us really quickly to say, can I just double check? I do have my membership in place before I step into the interim, before the surgery and obviously being able to hear back that. Yes, you do. That's ok. You're covered uh before you perform the surgery is going to be really important. So it just shows you how many people we assist. Just the top left. One there we assist. Well, over 99% of our members, it's actually 99.7% of our members we assist, which very huge number we might still be thinking, why is there naught 0.3% who are members? You don't assist different indemnity providers offer different types of indemnity. The one we offer at the MDU is probably the most common you'll come across. It's called occurrence based indemnity, which you don't need to remember the specific terms. All that really means is as long as you are a member at the time of the incident, we are able to help you. So, say your first year being a doctor at, for argument's sake, say you started an F two and you had your membership. Um, and then 20 years down the line, you'd gone traveling or you've taken parental leave or you've, whatever it might be, you've gone to a different organization, it doesn't matter. And you get a call saying something has now happened from 20 years prior when you were on F two, that you're being caught up a, caught up from, maybe they're trying to make a claim at this point. There's no time limit on when this kind of thing can happen. It doesn't matter that you're not currently a member because you were 20 years ago when you performed said treatment or performed, said surgery, whatever it might be. So we were still able to help you that 1.3% comes in if it's the opposite. So you didn't have F two membership and then four years later you were a member, but they've called from something about when you were in F two. You say you might think, oh, I remember now. It's amazing that you can help me. We would, we, we aren't able to help you if the incident happened before you became a member. So it's, it's still the majority, you're able to help, but it's all just about making sure the past is protected. So hopefully, II make that sounds a lot more complicated than it really is. So it's sort of just making sure everything you've done in the past is protected really. And that's what occurrence based means. Next slide, please. Ok. So I'm just going to go through a couple different points then, um, next slide, please. Um, just to talk about a couple of different areas we help doctors with. That's the main bit about the MD and who we are and what we do. So obviously a huge part of our work is er, supporting doctors if you are under a GMC investigation, which is obviously an incredibly stressful time period for a doctor. The most important thing for you at this point is going to make sure you do have that legal support, should you need it? Um, I do wanna say it's G MZ investigations do not happen to that many doctors, it's not there to scare you. It's more about it's going to be a lot less stressful if you do know there's support behind you and you know the formalities about how it all goes on as well. Um, but yeah, so a lot of things can happen with the GMC investigation. Your reputation is being publicly challenged, depending on the situation, it can be, it can involve a high amount of press in the media, they can take a long time for cases to be concluded. Generally speaking, a GMC investigation lasts between six months and two years. So it's a long time for that to be wearing over your head and any future job applications, you would have to declare it as well. So it can, it can be something that lingers next slide, please. And just um I know this ends in 2020 but which it seems ages ago now, but the pattern it shows does continue. So it is still valid. I think this is quite um a nice table of statistics once you look into it. So looking at the doctors on the register between 2016 and 2020 it's gone up by a huge amount. Almost 60,000 new doctors um registered with the GMC and from 2020 to 2024 now it's going up and up and up, which is obviously a fantastic thing for, for the UK and for doctors. Um Yet I think it's really useful to know the line below the amount of inquiries into these doctors is decreasing, which is fantastic. Mostly it's going to be because of improved training, better education, uh high quality and more accessible resources, whatever it might be. I'm sure we can all agree to not because people don't complain as much if anything, people complain more now. Never so clearly. Something here, something is going very well here for doctors, which I think is quite a good sign. And also you'll notice there are loads of different people that can um refer a doctor to a GMC investigation and the majority of those come from members of the public and this is why the majority don't get, it's not that they don't get taken seriously. Everything gets taken seriously, but they won't meet the threshold for actually. Is, is this doctor fit to practice? Because that's what a GMC investigation is looking into. Is it safe for you to be a doctor? Yes or no. A lot of, um, public complaints are going to be things like someone couldn't find parking or they slipped on the floor or they, or even they thought their doctor was quite rude to them, whatever it might be as soon as this hits the first stage of the GMC process, they're going to realize this has nothing to do with us. You can deal with this in house if you like, but it's really not necessary. So just being referred to the GMC doesn't necessarily mean anything serious is going to happen. In fact, the majority, your initial referrals do get sent away straight away, but they can come from other sources as well. It can be, it can come from within the hospital. So the nurses, midwives, fellow doctors you work with, um, and it can also come from sort of third party places like the coroner. If you're in the coroner's investigation, they could notice something and refer you to the GMC or one that's quite common as well. Well, not quite common but you see, probably more than you'd expect to the D VLA. So if a doctor has been called drink driving and obviously the D VLA notice on your records that you're a doctor, they can refer you to the GMC themselves because obviously that could pose a potential risk to any patients that doctor sees. So there are loads of different people that can be involved in this. But I think it's a good sign that there are more doctors and fewer enquiries next time, please. And this is just a flow trial just to show you the process of a GMC investigation. Like I say, this whole thing can take on average maybe a year and a year and a half. So it's a really long process and you can have your defense organization there at the very beginning as soon as you've received the complaint or even if you're worried, you're going to receive a complaint, there's never any point that's too early to get your defense authorization. Um to, you know, to be on, not always be on your side, but to, to have them there talking you through it and be able to, um, go through the whole process with you all until all the way until the very end. So you'll have a complaint made to the GMC. The GMC registrar will then decide whether or not they need to investigate. And like I say, that's where the majority are going to be sent back because they don't reach the threshold. If they do choose to investigate, there'll be case examiners which are left to make a decision. Four of which, um, decisions can be made, there can be a warning which is obviously the least serious of them all. Um, an undertaking which might be, they want you to retrain the insertion area or they want you to be supervised performing insertion tasks. They could still choose to close a case at this late stage or obviously the worst case for a doctor is they could refer you to a fitness practice tribunal hearing. Which next stage please, if you are referred to a hearing, it is the Medical practitioners Tribunal service that uh hosts these, which is in Manchester, if it's in person or they do a lot online, especially since COVID and from that investigation, there are four, again, four possible outcomes. One again, even at this very, very late stage, they could decide, actually, we've got loads of information. We don't think this doctor is um not f it is not fit to practice, they're absolutely fine to get back to work. They could impose conditions which is similar to an undertaking, retrain supervised, whatever it might be, you could be suspended, either with or without pay or the really scary word. Um The people don't really like to hear about is a doctor can be erased. So being erased is the formal term for being struck off. It means you know, you may have your medical degree, but the GMC is no longer allowing you on to register, you're not allowed to practice medicine anymore if this were ever to happen to you. And like I say, it's happened to a very, very small amount of people. You have to wait a minimum of five years before you can request to be reregistered. It's very unlikely the GMC will reregister you. That doesn't happen to many people for the majority. If you have been raised, that is the end of someone's medical career, um, very quickly moving on to the next slide because I know that's very daunting and worrying for people. Like I say, it happens to very few amount of doctors so out of around 340,000, even more. Now, about 1000 investigations happen every year, fewer than 100 100 of which will be suspended and even fewer will be actually erased. So they do not happen to many people. And the easiest way from all the work I've been working for the MD now for two years and I have attended these, um, investigations myself. The easy, almost foolproof way of making sure you don't have, you don't end up in that little red circle with being suspended or erased. The main thing that GMC care for is your honesty. The only reasons I've ever heard of any doctor being actually erased is because either something they've performed some sort of illegal action, which very understandable that's going to get you in a lot of trouble. Um, or because they've been dishonest about what they did or about, um, how something went about or about their own qualifications before getting a certain role. If you are honest as early as possible and you show how you're going to try and improve on this and how you're going to make sure this mistake doesn't happen again. You should be absolutely fine. So it's not there to scare you, but I just think it's that the earlier you understand all this kind of thing, the more beneficial, beneficial it can be uh next slide please. And next one please. And then you also have so sources of complaints. So again, this is a huge part of, of what we do is looking after complaints that come through to the NHS. Um I don't know if anyone is aware but we receive about um 5 to 600 complaints, written complaints to the NHS every day, which is gonna be taking up a lot of, of er doctors time to have to deal with and have to respond to complaints can come from any of these people as well. So very, very similar to GMC investigation. Just internal complaints can come from other people in the, in the hospital, but it can also come from the public and um other people acting in the public capacity as well. So like I say midwives, nurses that sort of thing. Next slide please. And the majority of complaints we see have nothing to do with a doctor's clinical ability or your knowledge or any sort of medical ability at all. As you can see in the green section, your honesty and fairness and the dark blue section. Professional performance. Almost half of complaints that come through are to do with the customer service side of the job, how you speak to people, the manner in which you talk to people, all of which is something that might seem very easy to fix and easy to not have to ever deal with. But it is also very understandable. You know, if, if you're working an extraordinary long shift and you're tired and you just, you haven't had an opportunity to eat anything or you, you've, it can be quite common if you've just been to see one patient and they really are quite unwell and you go to see another who in contrast isn't the idea of, oh, this person's wasting my time or why are they here? Which is, can be a very much unconscious thought that you have can unfortunately slip out um into that situation and that sort of thing can cau is what causes the majority of complaints, which like I say, isn't going to be too serious for you as a doctor, but it's just going to use up an awful lot of your time. Like I said, it's almost inevitable. You will deal with certain complaints that's not to scare you that hopefully um helps uh helps deal with it if you ever have because it's just inevitable. It happens to all doctors. But trying to um limit the amount that are going to come through is the easiest way to do. That is just by there's the acronym halt. So if you're hungry, angry, late or tired, trying to take a breather before going to speak to people. Um we talk about the golden minute. So on average patients are interrupted within the first seven seconds that they start to speak, giving a patient that golden minute. Should they need it to just talk, speak in? Um uninterrupted to say anything they need to say, just set off on a really good first, you know, first bit of that doctor patient relationship and going to really reduce your chance of having to deal with any sort of communication complaint which like I say makes up the majority next slide, please and negative, please. Oh yes. This is just more about what I'm talking about with the complaints. So that, oh they so in 2020 to 2021 we had an average of about 500 written complaints coming to the NHS every day, which really is going to stack up by the end of the week. You know, you've got loads and then adding up. It's it, they are something that's really common, which isn't very comforting, but hopefully will help, help you. If you have dealt with anything, it's obviously important to work, work with your colleagues because there's a good chance someone else or especially someone, perhaps someone higher up has definitely dealt with something similar before. So being vocal about it and not trying to do with anything on your own, I think is really important. And like I say, any complaint you've, you've, you, you've been dealt with or you're dealing with will not be the first time we've heard it at a defense organization. So there will be support out there for you neck side, please. Um Yeah, so this just shows you again the different types of support we can give people so we can, uh we have our, we have our own legal team of both solicitors and barristers who are all medical specialists. So this is what they, this is obviously what they do, what they um specialize in. We can represent you to a criminal trial. Um, we can represent you at a, if you asked to attend the Coroner's Court, um or any sort of investigation, if you've been asked to write a witness statement about anything or anyone, that sort of thing, if you uh any indemnity for claims. So if someone is making a, a claim against you, when I spoke earlier about the difference between NHS Indemnity and er defense organization indemnity, I missed out. So the only main thing NHS Indemnity will help you out with is if you've had a claim made against you. So the NHS have a pool of money to help. If any of their staff have had claims made against them, they have finances to be able to support it. They may not necessarily have enough money to support the whole thing. It might result in you forking out yourself. Whereas obviously as, as a defense organization, we take the full front of the, the money aspect. So you shouldn't be paying anything for yourself. The only thing you would pay is your annual membership. Uh nl please. So yeah, so because of obviously, the amount of complaints do come forward and that's obviously what we specialize in. We have developed a peer support network. So it's a, it's a way for you. You can do it anonymously as well to be able to speak to your fellow doctors and try and see if anyone else has been in sort of a similar situation you've been in has been in your shoes, you can speak to someone else who might be able to help. Um And yeah, of course, you've just got all the sports on there for you as well. II think I've spoken about that enough already. Just next slide, please. So looking at the memberships themselves. So obviously, what do you get with your membership? Any indemnity for work not covered by the NHS, obviously, including all the claims side that I've just mentioned indemnity for Worldwide Goods Marit Act. And like I say, completely worldwide, whether you're on a plane, whether you're anywhere, that no problem, 24 7 hour medical legal advice line staff by actual doctors and everything else you can he see here, I'm not going to go through all of them, but around the clock, media advice as well. Um It's a really important one but yeah, you can move on. That's great. Thank you. Um Yeah, and lovely. So what I'm going to ask for you is everyone who is here, if you could please either take a photo or scan the big QR code on the screen here because what we're going to do is obviously it's a bit difficult with obviously IM GS yourselves to know when you're going to be coming to the UK and when we can get your membership up and running, if you're able to scan the QR code, what we can do is we can grab some of your data, email or phone number or whatever it might be. So that when it does come to the point of when you are returning to the UK looking to start work, we can then uh in a timely manner, get your membership up and running, which is going to be really important. Just might save you a job if we can contact you, it saves you trying to reach out and having to remember all the things you have to do in regards to how much membership costs it is going to depend on what you're doing. So if you do start um on the official uh foundation program, then the I know for a lot of you, you, you can jump straight in as an F two. So how it works is the F one membership is 10 lb for the year. F two membership is 20 lb for the year. And we, we always do our membership for one price for the whole year. We don't, you, you can choose to pay monthly, but you have one price for the whole year basically. Um And if you do, if you are starting as an F one, you get the choice of either the foundation program or a box of clinical study cards as a free gift. And if you're starting as an FT, you either get a diagnostic dilemmas book or an Amazon voucher as well. Um But if you are, obviously it's going to depend on what you're doing. So, like I say, that's for people on the official foundation program. If you're not on the official foundation program, obviously, you won't know much really until close to the time. You may start as what we call like a general hospital doctor, a non consultant, non consultant, hospital doctor as well. Um And the price for this is going to be a bit more, it's probably going to be closer to 80 lbs, but I will just be for the year you're doing that and your joint or the similar um training program and similar prices that everyone else has been on. So it might just be one year you're paying slightly differently. But the, the amount you pay uh is just going to be case by case dependent, but it's going to be that sort of price range. Um And yes, yes, it just depends, just depends on what you're doing. Really? Yeah. So the good thing about if we get your details, you can speak to a membership team, let them know what you're doing and what sort of work you have and they can make sure the price of paying is accurate to what you're doing. The, the reason it's different is the, the more you pay is because you're a higher risk doctor effectively. So obviously a foundation doctor is left with a lot less responsibility than perhaps a general hospital doctor. You're sort of jumping straight in the deep end. So there's a higher risk which is only makes fair that you do pay a little bit more because otherwise if everyone was paying the same, it wouldn't work out quite, you know, it wouldn't quite be fair. Obviously, if you're a private doctor down the line, you'd pay more than NHS doctor full time more, you pay more than part time and your actual specialty is something that can, can affect the amount you pay as well. So obviously you shouldn't choose your specialty based on the aspects like this. But I think it's just quite interesting. Um, something like obs and Gynae was notoriously more expensive. I mean, especially, you know, for an obstetrician, you have at least two patients if not more. So that's, you know, a reason for it to be more expensive compared to something like dermatology is notoriously a lot cheaper. Obviously you need to choose, um, whatever you're going to enjoy basing your career on. But no, the price is all just dependent on how much of a risk you are as a doctor to how much resources we think you're going to need from us. Yes. And then uh next slide, please. Uh When you do sign up, I'd suggest say yes to the emails again. So it just gives us a way of contacting you. Um We can also look on the website and you can find loads of um our membership, contact details there and how to contact us. Should you need to. They might just save you, save you a job next side, please. Um And we also have an app if anyone has storage on their phones, which no one, no one ever does nowadays. But if you'd like to just have your membership there on your phone, especially when you do get closer to actually starting work. It can just make things a little bit easier, closer to the time that's up to you and final like these lovely. So here is my um email. So if you'd like to take a photo of that, you're more than welcome to. And any questions you have about the MDU about indemnity, about how to start your membership or when you're coming over to work in the UK or whatever it might be. Um, feel free to feel, feel free to send me an email that's out to you. No problem. I wouldn't give my phone call the number. It, my SIM doesn't work so you won't get through to anyone. But yeah, definitely send me, feel free to send me an email. That's no problem. Um And yes, I hope you have not been talking for too long. That was a bit of a well, quick run through of defense organizations and how we work. Were there any questions at all? If, if I could just add to what, what Sarah said? Thank you, Sarah. I have some amazing information. She made a very, very good point there as well. Um, about honesty being the most important thing. When it comes to making mistakes, everybody will make a mistake. Some of those will be, you know, big mistakes, some will be small mistakes, some will be um, incidental, some will be mistakes that everybody makes. But as Sarah said, it's the main thing is, is not the mistake, it's what you do after the mistake. Ok? You know, you can screw up. But if you're honest about that screw up, you've taken action to make sure that you mitigate for any further damage that you have a duty of candor that you've shared everything that you can. Sarah makes a very, very good point there about being honest when it comes to these kind of things and that means also being honest with the MDU um or whichever organization that, that you might use to work with. No, absolutely. I mean, the reason we exist, the reason defen exist as a whole is because people make mistakes and absolutely your, your duty of candor. So the honesty, I mean, also it's not just a case of you making mistakes but other people around you making mistakes that pull you in or, like I say, with our, with the initial case of Dr David Bradley, um, being a, being a of something that perhaps wasn't true but nevertheless realizing there's probably a best way to go about it or whatever it might be, um, having that support there. So it, it, it's, yeah, absolutely not there to scare anyone at all, but mistakes are something that happen in every job and that's the reason the defense organizations exist. Absolutely. Well, Sarah and Doctor Aaron, thank you for adding on, but Sarah, thank you so much for that talk. I think it can be quite daunting, you know, for a new doctor, um, especially if they're coming from broad and kind of not knowing where they can get sort of sage, er, legal advice from. So, you know, thank you so much for that. And I think it, it's reassuring to hear that the MDU are so easy to get in touch with. You mentioned the helpline and, and the professionals that they have on board. So thank you so much for your time and you know, we hope to see you again. No problem. Thank you very much for having me. Like I said, if anyone has any questions, feel free to email them over or if you didn't get the QR code, I can email that as well. But thank you very much. Thanks for having me. Thank you so much for your time. Bye. Ok, so thank you guys for um sustaining and, and listening to that, I think it was, it was very important. Um and she made a lot of very good sort of age points about er medical legal defense. So without further ado, I think this is what everyone was also waiting for to come. I it's my pleasure to introduce or reintroduce again. Doctor Aaron, er, Doctor Aron was a medical university. Sophia alumni graduate just like ourselves from class 2023. Um after completing medical school, Doctor Aaron went through the gateway program and he went through some very kind of thrilling specialties, stroke medicine, er, acute medicine as well. Currently, Doctor Aron is now in cardiology and he brings to us a very interesting talk about breaking the bottleneck and sort of the challenges that come with finding jobs for international graduates like us in the UK. So without further ado Doctor Aron, take it away. Hi guys, I'm, I'm assuming that everybody can, can hear me. Uh, good. Ok, so we'll, er, we'll kick off. Um, I'll just share my, er, my powerpoint screen so you guys can see DD DD do. Ok. So, er, if at any point, um, it stops moving, can somebody just, er, cos I can't see the chat now, obviously cos I'm just showing my whole screen but if at any point there's any kind of communication breakdown, if someone can just jump in with the audio and let me know that's either not, er, cycling properly or if there's any kind of, um, any kind of issues, that's fine. I'll do that. Fantastic. Ok. So, er, the title, er, as you already mentioned is beating the bottle neck. So, so who am I? So my name is Doctor A Baines. Er, I finished my last exam. We can't see your screen. Are you can't see the screen? Hang on one second, 22. Mhm. How about now? Can you see it now? No, how about now? Ok. Yes, you can do, I can see that now. Thank you. And you can see the full screen. Ok. Right. So, um, yes, who am I? My name's Aaron Baines. Uh, I finished, er, my last exam, er, on December, um, 22. Very emotional day. Er, I was crying. A lot of people were crying when they finally got their last, er, grade. Um, I graduated in February 23. I had my full GMC registration in April 23 the same year and I had my first F one posting um, in August of the same year. So you can see that it took me about six months from having my full, er, from my graduation, er, until, er, landing my, my first position, things obviously have changed. So that's what we were talking about today. I'm currently in the second year of the Gateway Foundation Fellowship. Um, I've hit all the targets that I've needed to hit. I've passed my A LS. Um, we had to do a little mini ay, I'll explain about that later. I'm sure most of you guys know that OSK are undergraduate exams but I'll explain why we had to do that. Um, and now I'm working a full, a full time on call, er, sho rotor, which means long days, weekends, er, nights. Um, because I've got my air, I can hold the, the crash bleep, um, and various other on call bleeps as well. So, um, yeah, it's, uh, it's pretty full on at the moment but I love it. So, what do we, what does a bottleneck mean? What, what is the, the point of, of, uh, of this, uh, this talk? And these are the five things that we're going to be discussing today, um, that are affecting um people from, even from my year, still applying for jobs and people from subsequent years uh applying for jobs. First dose being the market factors that are specific to the NHS, um which is causing a bottleneck in terms of the number of positions available. The second thing we'll cover is, is competition um from er, other international, er, medical graduates who are also trying to enter the UK market. Um and how that, that, that affects you guys. Um, the third thing we're gonna cover is competition from auxiliary and ancillary staff um from within the UK job market, from within the NHS. So we're talking about internal and external factors um, that are making it more difficult for people to find jobs. And the fourth thing we're gonna talk about is, is as with any socialized system of medicine, resource management is, is one of one of the overriding things in the system of, er, of private medicine. Those things are less of, uh, less of a bottleneck. I can give you a great example. If you were to get sick in America and walk into a hospital before you even see a doctor, they will give you a battery of tests, x-rays, scans, bloods, you name it, they'll do it and they'll hand that report to a doctor in the UK. You see the patient first and then you order which exams, uh, you think are needed and some of the exams that you need for example, an MRI or a CT, you have to sell that to the radiologist. Um You can't just order it and it'll happen, you've gotta call at the department and justify why you're having that. So, um, that's about resource management within the UK market. And the fifth thing we're going to talk about is reputation of UK. Bulgarian graduates within the UK job market compared to other IM GS compared to UK graduates compared to subsequent years as well. Um, but again, we'll, we'll cover that through the different slides. Uh So let's, let's kick it off. Um First thing we wanna talk about is are market factors that are specific to the NHS hindrance, positions that are available. Now previously for the UK graduates, they would go to medical school. You try as hard as you can, you do as much as you can, you present, you try to get on a research project, you try to do as many things get published and all of these points were added up and you could use those points at the end of your medical degree to um, go for positions or ci cities or places that you wanted to go to. The higher the points that you had, the higher, the chance that you were gonna get your first choice. So if you're from er, my part of the world Ascot and you wanted to work in Friley, your parents live in Friley, you went to school in Friley, but you went to University of Leeds, but you don't wanna stay in Yorkshire, you wanna come back to Friley, um which is quite an over subscribed area. What you do is that you work your butt off at university to make sure that when you put down that deanery, you're more likely to get that first choice that system has now evaporated in the UK. So, and that's, that's been dropped on students. So this year's first, this, this, these f ones that have come in this year for the first time, um are the first guys who had a completely random allocation. They're annoyed about it because they didn't find out about it until the middle of their fourth years that hey, all the, the last 3.5 years of study that you, that you did, you know, going the extra mile won't actually carry any weight at the end. Now, the rationale behind this in the UK was to prevent the best doctors going to the best cities. So obviously there, there was some, some thought about it, but I think they've probably gone about it the wrong way because what you do is end up de incentivizing people to work extra hard at medical school. Because if you're all gonna be thrown into the same pot, then what is the point? So they, so they, they are looking, looking at this. Now, how does that affect positions in the NHS? People are, are taking positions on foundation programs and they try to make it work for them. They, they try to stay in, you know, Newcastle, even though they're from the South or, or vice versa. And when they're fine that the struggle is too much and it's not what they were sold initially when they went to medical school, some people are dropping out of their own f one positions um and taking up um um kind of direct entry routes. I in other trusts that they prefer to work at. Now. What that means? It has caused a bit of, of a chaotic situation in the NHS in so far as some um f ones did not know where their postings were going to be until two weeks before they started their jobs. So they were frankly running around trying to, you know, if you suddenly find out on a Monday morning that in two weeks time, you're starting a position in Newcastle, you need to get up to Newcastle, you need to find a job as a, an apartment. You need to figure out how things work. You know, you might not drive, how I'm gonna get to work. Um There are inductions and so so on and so forth that you have to get to. So it's caused absolute chaos. It's normally some, a guy in an office who's probably never worked at death medicine in his life who's come with this idea. Um um And it's, it's not working for anybody at the moment. But, and so these are causing unnecessary pressures, um, on F ones, um, UK graduate F ones and the fact that there's so much dynamic movement now people trying to, you know, um, trying to find, uh, what they, what works for them as opposed to what's been given to them, you know, before they could work hard. And they, and the, the, the, the reward for working hard was getting that position at that trust or that deanery that you wanted to since I got, that's gone out the window. Um It's, it's, it's caused additional problems. The market also has fundamentally changed since I graduated when I graduated. And the year, um before, um, before me, nobody had any kind of problems getting jobs. Um, there are some people now from my year who are struggling to get to get work. Um And that's just because some of them um took time off to and which is, which is not unheard of even for UK medical graduates, some of them will get positions. Um and then take a year off and go and travel, travel the world because they've worked so hard for so many, so many years and they want just some time off and they go and do their South American Asian trips and then they return to the market. So, um there has been some real fundamental and heavy hitting changes. Um and we'll go through that and it it's, it's not just your year that are suffering or um not just the years that aren't going to be coming up. This is a, a market wide sort of issue. We're going to break these down now. So one thing we need to consider is competition between uh IM GS to get into the UK job market. So when I say between I MG and I MG, I'm, I'm talking about graduates from places like Canada who want to come into the UK. We have uh I work with two F ones who are from Australia who didn't get positions in Australia, who came back, came to the UK to work um competition between um different countries, for example, um II Indian graduates are held in quite high regard in terms of their clinical knowledge, but held in lower regard when it comes to their um clinical acumen because they, they don't, you know, do a lot of their own stuff. When they're working in India, they have nurses and ancillary staff to take blood and put Cannulas in. So a lot of these guys are book smart but not hand smart. Um Also in terms of the bang for your buck, what I mean by that is is that you may be applying for a position at a hospital. So, Shof two and you're up against somebody who's coming from another country, er, say for example, Egypt, but they're coming in as Regs and consultants or people who have taken some time out to have Children who have now decided to come back into the market, but they've decided to come back into the market in another country. So obviously, if you're looking at it from a resource point of view, if you can get a registrar for the same money as, as F two, you know, you think about your waiting lists, you think about your complaints, you think about your coroner's investigations and all those things are headaches. You know, we as well when, when, when I was a student and I'm sure it's, it's the same for many students. You guys think very black and white, you think? Well, you know, this is not fair. It's not always about, about being fair. You know, if you're, if you're working in medical staffing and you earn 30,000 lb a year and you're going through a divorce and you can't afford your car payments. You're not going to be thinking about, oh, that f one needs to position more than this other guy. You're going to think this guy who a red, he's going to be able to do more for me, which means my headache comes down. So, you know, even though they should be offering these positions to, to juniors and to UK Juniors, that isn't always the case. Just, just factor that in, no one's ever gonna call that out in a, um, in a overt way, you know, some of these things are covert, some of these things are just part of the human condition. You know, if you were gonna hire two people for the same salary and one person has six years worth of, um, of experience and the other guy had zero years worth of experience, automatically, you're gonna go towards a person with, with more experience, er, Brexit versus UK, um, immigration policy. So Brexit was, um, what's the best word I can use, er Bonkers. So, um now because of this exodus of European workers, because the, when the Tories pushed through Brexit, uh and we were all gonna be living in sunlit uphill uplands and driving jaguars and the roads have been made out of gold. Um They didn't actually factor in the human factor, which was if you are a Spanish doctor living in the UK and you can't bring your grandmother here anymore. You can't bring your family here anymore. You're not gonna stay here for the fish and chips. Um, my wife is French. She works for the University of York. It cost her 4000 lbs just to set foot into the country. 1800 lbs was for her um her skilled work visa and another 1800 lbs or something like this, maybe a bit higher was for the NHS surcharge. So, because you haven't paid any previous taxes or any national insurance before you start a position, you need to add that to your visa form. So that you can, you're not a drain on resources and you're not coming here just to use the NHS. Now, for many, many people who are coming here from the EU and you're paying for relocation, you're paying deposits, you're paying one month upfront. It's just not worth it, you know, especially cos the work life balance tends to be better in Europe anyway. So a lot of the European doctors have started um leaving or not trying to get access and the government have, have massive massive recruitment drives. Er, there are pages dedicated to these, there's a um er er, there's a page, I think I shared it on the, on the GMC chat. If you're not a member of it, I can send you the link at the end where they are actively actively recruiting doctors from India. You know, we will subsidize living cost, we will provide um you know, accommodation, you can bring your families, yada, yada, yada, there's also similar drives er, in um certain countries in the Middle East and certain countries in Africa as well. So to make up for this shortfall and it's, it's when I was work, I used to be a pharmacist before I was a doctor. Um there was a very, very similar drive for recruitment of Romanian and Bulgarian er Pharmacists Rowlands pharmacy who I used to work for, bought two houses in Salisbury, um five bedroom houses and they would house these pharmacists in there um, er, while they finished their GMC, er, registration process, er, and they would work for peanuts, um, eventually they would get their full GMC registrations and they had to work for Roland's Pharmacy for a couple of years. They're having these similar kind of recruitment drives abroad. Um, these aren't anything new, I mean, these, these have happened for decades but now it's, it's starting to become, um, er, a lot more, uh, of an aggressive policy, um, because no one really factored in, um, the effects of, um, of Brexit. Well, they factored it in but they factored them in incorrectly. And, um, um, so, yeah, it was, it was stupidity but unfortunately that affects the UK job market. So, next slide is about a competition from a, er, from auxiliary and ancillary staff. Ok. So these are members of, er, of the medical team. Again, this is down to resource management and cost cutting and positions have been created, um, to the way that they sell these positions to the public is that, oh, they're just support staff and they're meant to be helping. This is true. Um, er, I, if they were used correctly they could be a very, very powerful tool, um, to support doctors. But, er, when it comes to PA S they also seem to be taking some of the workload that was primarily down to doctors. So let's just talk about the difference between, between these, these three, these positions. So, a da as a doctor's assistant. Ok. They work with the junior doctors who support them. They, they're essentially clinical support so they can do stuff like, um, bloods, Cannulas, um, they can do, um, discharge summaries, um, but they can't prescribe medication. Um, and the route is normally it's a, um, it's not a nursing route. It's a HC, a, er, who can level up to, to a DA. Um, so obviously you've, now you've got certain members of staff who are able to do discharges and bloods and cultures and C, and Cannulas. Edans bloods and, and, uh, and candy are essentially what a lot of F ones are doing. You know, the difference between AF one here and AF two year, your F one year is where you're doing your basic skills and practice. Ok, your F two years where you build on your F one, um, and start preparing for your speciality years. So, obviously, obviously, if they've got people, um, who will work for less, who can do that sort of stuff like Edans bloods and can Cannulas, it gives, er, trusts, er, um, avenues to reduce doctor hours and fill those in with, with DA hours. Now, they, they are, they are not equivalent. Ok. Da is, is an A ta that has just been trained to do stuff like bloods and Cannulas, which is relatively, er, low level sort of stuff, but that does create a small measure of pressure on the job. Market now, pa s those things, those guys are and girls are different. Those are guys that are physicians, associates. So um they do two years of training. Um they can be nurses and midwives. So um a lot of them have already got degrees. Some of these are bioscience degree graduates. Um or you can even have a separate masters of PA program. So it's, it's, it's, it's more of a um less of a training program, more of a academic program. Um, you have direct patient contact. They, they work within hospitals, they work within gene practices. They can do histories, they can do examinations, they can do some diagnostic stuff. Um, they can do clinics, er, for chronic conditions. Um, they can help interpret test results and they can help develop, develop management plans. Now again, that is a lot of work that doctors used to do, particularly FWS. Um, in cardiology where I work at the moment. There are two PA S um, and they're sitting a long because they're there for a long time and they're there for a whole year. Whereas we rotate out every four months or so. So they can sometimes have more knowledge than you. And the consultants can, can sometimes put a heavy onus on these guys to do, er, to do work that should probably go to a doctor again. They're not equivalent of doctors but this is another drip feed, um, that's taking away, er, um, er, the number of positions, the number of hours, the number of financial resources available to hire new doctors. And that's what, what the effect is, uh, in terms of when it comes to applying for jobs. The other thing that we have are a NPS. These guys have been around for Yonks but, er, now they're getting used, um, in more senior sort of positions. It's a, it's a, to become an, an AP and advanced, er, nurse practitioner. You have to be a nurse first and then you become, um, you do a master's degree to become um an A NP. Um and these guys can do history examinations and they can independently prescribe. So, da S and PA S can't prescribe medication. But, um, but advanced nurse practitioners can, they're classed as independent prescribers. They have to do a, a prescribing course on top of the masters. So again, you know, if you're hearing stuff, like if someone's doing discharges bloods, cannulas examinations, histories, diagnostics, chronic condition clinics, differential diagnosis, test results, management plans and prescribing and what the hell do they need doctors for? So, again, these are reactions that come from a good place. It's all about resource management. So at the end of the day, they, they need to have enough money to treat everybody in the hospital and because of the, the way that are set up the amount of wastage, uh um the amount of bureaucracy, um um I think there's also a certain amount of, um we get the NHS that we deserve. Um So patients aren't helping. Um either. Um These are, these are all factors that, you know, have been developed because resources are just so tight and they have to figure out a way of saving money. So creating these positions which um you know, da S and PA S don't, don't cost as much as doctors. A NPA NPS can cost as much as a junior doctor, but there are two positions. They were originally designed to take the pressure off doctors. I'm sure you've seen in the news now that there have been PA S who have been running clinics and now they're, they're, they're gonna be coming under GMC regulation. We don't know how that's going to further affect the market. So, you know, these things weren't, these things were in the infancy when I was applying for positions and applying for the gateway position. Um, you know, they were rumblings and rumors and, uh, but now these guys are, are fully, um, on the deck, um, in different numbers, er, in different trusts. But you know, this, this is one reason why positions, er, sometimes can be difficult to obtain. Actually, that leads nicely onto, onto my, uh, my next slide which is cost cutting and tighter resource management within the UK job market. So one thing that has been costing the NHS millions are, are locums. So locums there used to be a way of picking up an extra shift now and again, um, um, just to keep the wall from the door, um, if you were thinking of becoming um, less part time, less full time because you had other commitments such as research or Children or anything else. Um, you could go on a local, um, er, base. Um, again, the human condition means that we are inherently selfish. So a lot of people just said, well, why the hell am I working with the NHS? And I can just do full time locum work and that's what happened. And I would say for about 15 to 20 years, it was a golden period for locums. People did not have to have direct employment with the NHS. They could work er, fluidly, of course, they didn't have, didn't have access to pensions or anything, but who cares, earning that kind of money. Um You saw a similar thing in, in, in pharmacy as well. And now the government has said, Geez Louise, look how much money we are spending on these locum agencies, not just locum for doctors, local for nurses and, and physios and other other staff. And it, it, it was completely unsustainable, you know, completely unsustainable. You, you're paying, you know, three times the cost of a fully employed doctor. Now you needed locums because, um, um, you know, this isn't a factory where, you know, Bob doesn't come in, ok. We'll make a few less buns that day. This is the hospital and you need to have a safe number of staffing. It's a legal requirement as well. So, um, a lot of these, um, er, trusts were between a rock and a hard place. You know, if we, if the GMC said that the minimum number of doctors on cardiology has to be six per day. We have five that day. We need to call in the local. So the locums are, are the mercenaries of, of uh of the healthcare industry. They are nurse locums, they are doctor locums, they are a dentist and, and, and there are are pharmacists. So um that was one thing which is a massive drain on resources. Um That's one kind of doctor, another kind of doctor is what I do, which is the Gateway Foundation Fellowship. Now that is run by an entity called um the NHS Professionals. What that is, is essentially um they, the NHS try to make their own locum agency. So they said look as opposed to outsourcing everything to a local agency. So, you know, oh am I paying for the locum? But I'm also paying for the, the bloody agent. I'm paying him a AAA fee as well if we have people who want that kind of flexibility. Well, why don't we do it in house? So that's what the N HSP program is. And the Gateway program is, has been taken under that umbrella just because they didn't really know where to put it. So they put the Gateway program under N HSP. So what does that mean? What are gateway doctors? So Gateway Doctors a few years ago, we met a woman called Doctor Helen mcgill. We explained that we were UK born and raised. Um and we were now studying in Bulgaria. She said, Bulgaria, we said, yeah, she went, you gotta speak Bulgarian. We said, nope, we're taught in English. She went what? So we bought her out there, paid for her tickets, paid for hotels and we got her out there. She met with a bunch of people and was very, very, very, very impressed with the people that she met and ran back to the UK and said, listen, guys, we're struggling to recruit, we're struggling to have people with, you know, good levels of English people like to have uh people who are from, from the same kind of um who have the same kind of cultural um um kind of wherewithal. Um I've just found a bunch of bloody UK passport holders studying out in another country, um who were dying to get back in the NHS. So they, they designed this gateway program initially for Bulgarian er graduates and then it was sort of uh expanded to all uh e eu graduates and now it's, it's warped and changed and looks different. But that's, that's what the foundation fellowship was um originally um designed for. So now to do now with the first guy is the locums, they're trying to do away with locums. So one way of, of that was either to push people into, um, N HSP or was to push people into trust grade positions. Ok. So that means that you're being employed directly by the, the trust. No agency. No locum fees. It's just like applying for a job anywhere else. This is what the market pays and this is what we're paying. We don't pay different for a Monday or a Tuesday or a last minute shift. This is what it is. So they made it and they're very clear to all agencies, local agencies that we were gonna, they're gonna stop hiring these guys because the money is getting ridiculous. And if your doctors on your books still wanna work, then they need to sign up and become either trust grade doctors or on the next line, become bank or, or have track jobs. Those are again, more flexible, they can be short term, they can be long term. Um, but again, for the NHS, it's a lot cheaper to hire these people internally and then you can have them work cos your contract will say that yes, you're attached to respiratory. But if you need to go through discharge lounge, if you need to cover, um, um, a AU AM U, you will do that, that, you know, that's, that's gonna be in the contract. Whereas a locum because you're essentially an independent contractor, they couldn't ask you to do anything else. You were being paid a lot of money. Um, and you were getting treated better than most doctors in the NHS. Because you could work as, and when you wanted to you didn't have to beg your boss for, for time off. Um, um, and you didn't have to do stuff that you didn't wanna do. You know if they said, oh, can you go and cover this, er, ship somewhere else? You could just say no, I don't wanna do it. So, uh again, in the human condition, er, a few people ruin it for everybody else. So now they, they are, it's an active drive to remove all locum agency staff from, from certainly from my trust and have them either pick up trust grade, er, positions or to go into the bank. Um, and then they can still have the flexibility but not being, being able to charge extortionate rates to the NHS the F two standalone program. That's um, another way uh of uh, of getting into, into jobs. Um, there's a misconception that, that uh F ones can't apply for the F two stand alone. That is incorrect. We already had one of our Gateway doctors who completed F one who's now also applied for the F two standalone program because he wanted to be closer to his parents and he didn't want to be in Yorkshire anymore. So he left after the first year of Gateway and he applied to F two standalone and got that. Some F ones who have had Children in after the F one year who were returning can also apply for the F two position. The F two standalone positions are few and far between and you have to go via the oral recruitment portal. Um You do need to have a full GMC registration to, to apply for that. So obviously, for you guys graduating from uh Bulgaria, that uh that's fine because you guys already have full GMC registrations. But there's a misconception that it's only open to, to people who may apply for any other position. No, no, no F ones can apply for those positions as well. And that goes back to one of my first slides about doctors who ended up getting postings to places that they didn't want to get, they could, they, they're allowed to apply for the F two standalone program. So that's dwindled, dwindled that as well. OK. So that's how they, all these, these different factors, how they affect the um the, the reduction in numbers, the long and short of it is, is that it's a problem with, with, with resources and cash every year. Every government has to throw a couple of extra billion um at the NHS. Um You know, that's a whole of the conversation altogether. Maybe it's the end of the NHS, maybe. Um You know, there's a uh a famous saying that if you put a bowl of sweets out for everybody and say, take 19 people will take one and the last person will take two handfuls when you've got a system like that where everybody wants to milk the cow but nobody wants to feed it. Uh, a system of socialized medicine may possibly collapse. It might change. It might just be that gps and A&E are just NHS and everything else you sort of have to pay for, it might become semi privatized like in France where it's, er, you know, if you want an X ray, they'll give you the money for the X ray. But if you want an expensive x-ray, then you need to top that up yourself, er, or heaven forbid, we were to go down the American route. Um, um, which I th I think is whenever you mix money and, and, and health, it's a caustic mix. But unfortunately, the NHS is a fantastic political, hot potato and often gets thrown around between different parties, um, rather than actually coming up with sensible long term solutions. So that's how the, these things, um, affect us. So those are some of the bottlenecks that, that, that we've discussed. Um, um, I'll just go through a couple of more slides about how we're going to, um, to overcome these things. But there's one important thing that we need to discuss, um, and it's the reputation of UK Bulgarian graduates within the UK job market. Ok. As I mentioned, I was one of 14, er, um, gateway doctors who have, um, er, who are on this current gateway program at my trust, different trusts have different numbers. We had 14 in our trust. Now, out of the 14, I already mentioned one person that's left because he wanted to be closer to his parents out of the remaining doctors myself. And another doctor are the only two doctors who progressed into F two. The rest are being forced to do F to repeat F one, if you were to tell UK graduate that we have doctors repeating F one, they would fall off their chairs because nobody repeats. F one, F one is taking bloods and cannulas, you know. Um but that's how poor some of these Bulgarian graduates are. We had a um, er, a grand round. I'm sure you guys have all have heard about ward rounds and then a thing called board rounds, which happened in board rooms and then a thing called grand rounds, which is where uh some of the top dogs will, will sit, er, over some expensive sandwiches and discuss a particular problem that week and they will, won't leave that room until they hammer that problem out. And we had to have a grand round because one of the um consultants said that he didn't believe some of the Bulgarian graduates had gone to medical school. That's unbelievable how embarrassing that sounds. So, myself and another guy are the only two that have progressed in onto the full sho rota. We are the only two that have gone full A LS. So we completed our, our, our A LSS which means that we can hold crash bleeps. It's, it's, it's no secret now that there are some Bulgarian graduates that cannot compare to other eu graduates when you see people coming out of places like Czech. Um you know, because Czech doesn't allow you to do endless exams after exam, after exam, after exam, you, if you fail twice, like in the UK, that's it. You're a done deal comparing Bulgarian graduates to places like India, Pakistan, Egypt, um, Middle East. Um, and even, you know, other kind of eu graduates who are non UK passport holders, you know, the, the, the feedback is just, is, is abysmal. We have a reputation for being very, very slow learners. We have a reputation for learning on the job. You know, from, from day one, if, if a consultant says right, Aaron first job go and get blood from room six. And I had to ask that doctor, can you show me how to do bloods? He's gonna say, well, hang on a minute. What the hell were you doing in medical school? Cos that's what you're meant to be doing in your 3rd, 4th and 5th year is taking bloods. Er, and I can't even do it on my first day. We have a reputation for having zero experience. Ok. And I've put the elephants in the room, we have a reputation for cheating. Don't think that people don't know. They know and you know why they know because doctors like myself, doctors are meant to be honest. So when the Gateway program came to us and asked us for feedback and said, look why are some guys just seem to have the knowledge? And other guys don't even seem like they even studied anything. We're not gonna lie, we're not gonna lie and say, oh, we've got no idea if we know what the answer is because that's how you generate solutions. And there is so much cheating at some of the universities in Bulgaria. It is absolutely mental. If the GMC actually had a proper handle on it, I guarantee you, they would, they would pull Bulgaria off their approved list. Now you can't stop other people cheating, ok? But cheating is not going to get you these positions. You only a doctor of, of any kind of substance can talk to somebody for five minutes and within five minutes they will know if this person knows his stuff or not. Cos there are certain simple questions that you can ask a person and if they can't get it, you know, this guy has been, has not been studying or has been cheating. Ok? You know, it happens. I know what happens. You've seen it happen, I've seen it happen, but to not discuss it in this forum would be an insult to everyone's intelligence. Ok. So we've got to start raising the reputation of Bulgarian medical students. I mentioned earlier that I had an OSK to progress into F two. An OSK is an undergraduate exam. It's normally 14 stations and each station you have two or three minutes and they ring a bell. You go to the next station and each station is something different. An X ray, um, breaking bad news, er, phone call to a registrar. Those are undergraduate exams. You don't do them as a graduate. They made us do that because they were, they said if we, we cannot put you in charge of patients because people will die because you guys are not ready. So we have to have an osk and as I say, only two of us got across to F two where we have our own patients. Bleeps, crash bleeps, yadda, yadda. Now make about what you will and I'm sure that there will be questions in the, in the Q and A but it's a reality. Ok. And we need to overcome that, you know, um my trust, which was a trust, which was one of the Mi Yorkshire trust was one of the trusts which had the highest recruitment of Bulgarian doctors per do capital. So my first ward that I went on to, which was an acute medicine award. The two F twos were Bulgarian graduates and positive it was me and myself who were other Bulgarian graduates. Um They had the Gateway program, they had Bulgarian doctors on the truster grade doctors in track jobs. They've done, they have, they have dropped out, they have dropped out of the Gateway program because they say these guys are too resource heavy. We don't have time and we don't have the resources to teach these guys medicine. Ok. They're not ready to be doctors yet. So obviously that has had a massive, massive blowback. You know, trusts are now, I'm sure many of you who've tried to get on the program are finding it difficult because there are many, many trusts pulling out the program because they're like, well, what's the point? We may have just hired trust grade doctors or, or, uh, or, or bank or track, er, er, doctors or he, he will hire locums, at least locals know what they're doing. At least locum knows how to do a job and we ask them to take a blood or put a cannula, he can do it. He doesn't need another doctor to come and show him that's too resource heavy again. I'm sure there'll be some, some toing and froing on that from the, uh Q and A. We can, we can go through that, um, how to beat the bottleneck. Ok. So the word that I've, I've, er, written in, um, in upper case there experience that is the number one way that I have seen people get positions and I've seen people walk into positions 4 to 6 weeks after getting their GMC licenses. One of my best friends, she walked straight into a position and she walked straight into A&E, ok, just like any other well qualified, well read doctor. Should you know why she did that? Because she did attachments in every single year. Look guys, if you know that you don't have the experience, if it's coming up to fourth or fifth year and you've never taken someone's blood, you've never put in a cannula. That's an indication to you that there is something seriously missing. It's all well and good going to festivals in the summer or going to see your mates or just chilling in sore away from your parents, it's not gonna get you a job, ok? FIFA ain't gonna get you a job call of duty. Ain't gonna get you a job experience is and we know that we don't have enough clinical experience in Bulgaria. So you have to go and get it. No one's gonna give it to you. Ok? So if you could do attachment in 1st, 2nd, 3rd, 4th and 5th year, you will walk into a job, you will moon walk into a job, ok? It will be a, a walk in the park. If you don't have any attachments, you are going to struggle and the people that I graduated with who still don't have jobs at the moment, the reason they don't have jobs is because they didn't have any experience and now they're scrambling around for attachments, but you're, now you're 23 years away from when you graduated and your, that sea that you were in has suddenly got bigger by two more cohorts. OK. So don't put yourself in that position where you're trying to scramble for attachments after graduation. Get them done. Narrow. OK. Experience is the biggest way to smash that bottleneck into pieces. What experience does it gives you, it gives you an understanding of the NHS. What the sight, sound and smell of the NHS, the NHS is not just a place that you go to work, it's an ethos, the system of socialized medicine, the system of total support from cradle to grave. OK. You know, there are some other countries which also have robust health systems but they only deal with your health. They don't deal with, you know, if you need a wheelchair or ramps or a stair lift, put in the NHS, that's what we do. We, we look after you from cradle to grave. So understanding what it means to work within the NHS and the sight and sound and smells and who does what and, and what departments do what? So having that experience where it becomes almost like a second language to you when, so when you're in interviews, you're, you're, you're talking the talk. Um and if you can talk the talk, they figure that you can walk the walk um leveling the playing field. So prep a lot of, er, UK graduates have a lot of stuff like interview preparation. Um, they know about portfolios, they know about personal and professional developments, they know how to do reflective cycles. They know what a Gibbs reflective cycle is because in Bulgaria it's more traditional. Here's a science go away and, and, and practice medicine. Whereas in the UK, they tend to have, you're on a leash which is, it's, it's the leash is there for a reason. The leash is there to keep people safe, patients safe. So, you know, you're not just practicing kind of as you want. You know, it's, it's the system of ABCD E approach to a patient that has been developed because that's been seen to be the most effective and safe way of assessing AAA patient and having everyone doing it at the same time means that when you go and see a patient, you don't have to look in 10 different places. You can just look for the ABCD E. So having to live in that play playing field means understanding what the UK grads get, we don't get the portfolio preparation, the access to research. You know, we don't do a single academic piece of work when we're at university really, you know, there's that, that thing that we do for um I think it was for sociology or Ethics. We do a, a couple of lectures but they, they're not, they're not research papers where you're using a bibliography and, and using Vancouver um, referencing and stuff like that. So, you know, there's, there's so much that you do miss out of, um, um, that you don't get from, from the Bulgarian experience. Fortunately I had, because I did a degree in the UK first and then a degree abroad. I had that access. I saw what it was like to be an undergraduate in the UK and it's not just science, there's so much more stuff, open and closed body language, open and closed, er, questioning how to even how to position your chair in front of the patient. You know. So um try to try to also have a look at, at, at how the UK students are, are, are prepped when you're having attachments, build those relationships. I've had some people who have come on attachments with me and it's like dragging around a block of wood, you know, you ask this guy a question who, oh, I don't really know. He's smiling and I'm like, why are you smiling for? You should know this answer. This isn't a joke. This isn't a high school. What, what's, what's wrong with you? Develop some professionalism? OK. That's, that's, that's another big thing is that, you know, the in the UK system, they have a wall of attrition before you get into medical school, personal statements, er, and interviews. So they can see, you know, does this guy have more than just a science? Can he be a professional in European medical schools. The attrition is through the medical school. So, you know, you have people dropping out or repeating years. Yeah, so on and so forth. Whereas in the UK, they tried the attrition before. Ok. And you know, there are guys probably in your year, probably guys that you've seen today that you wouldn't put in charge of a hamster, let alone a human being. Ok. Again, elephants in the room, I'm not here to shoe coat stuff, guys, I'm here to tell you what the, what the realities are uh becoming indispensable. So within my f one year, um II I didn't know what the word. No was. I put that word. No in my pocket and I left it there. Ok? Anything they asked of me? They, I just said, yes, Aaron, can you cover this shift? Yes, Aaron, can you go and do this? Yes, there are some other people who, who are still looking to get long term contracts on short term track contracts and you know, medical staff and ask you, hey, um do you mind doing this? I don't really feel comfortable doing that. Ok. Medical staffing won't forget that the other day. Me and my wife, we wanted to book a trip to Venice. I was in trouble. I forgot to book it off from, from work and I had to give 42 days notice. I called up medical staffing and I said, guys, listen, I screwed up. Ok. My wife is gonna beat me. Ok. I need these days off. They said, ok, Aaron, look, it shouldn't be happening. But let me see what I can do two days later. Bang Aaron, you've got the time off, but don't tell anybody becoming indispensable, er, dispensable. I meant indispensable, becoming indispensable is one of the, the, the number one factors that allow you to progress when I was going through. I said to them, I said, look, guys, if you think I'm performing well, I want, I want stroke, I want cardiology. No one requests their next rotation. OK? But there is a certain amount of politics involved in any job that you go for. OK? And if you do for them, they do for you. If you scratch their back, they will scratch your back. So for that first year of becoming a doctor, no, that word doesn't exist. Everything should be, yes, you'll be tired, ok? You'll be maybe a little bit down, ok? But in that f two year when you are the go to guy or girl, you're gonna feel grateful that you put that work in. I know I don't wanna be uh catastrophizing or, or um or b Blitt anyone else's eee experience. But it is like a, it is like a war, a first year is like a war. You know, you can say no to stuff or you can say yes to stuff. So you can say no to stuff and I ended up doing Edans and Cannulas or like me, I put in a Ryles tube in my f one year. A Ryles tube is a surgical job. The surgeon couldn't get it in. So I said, let me have a go and I inserted a Ryles tube in my first year. Ok. So another friend of mine, uh, he did, he did an LP just at the start of his second year. Ok. So be indispensable the word no, doesn't exist. Uh So that's everything I had to say. Happy to take some future questions. Um Guys, all the very best for the future. One other piece of advice that I wanna give you is enjoy your medical school. Ok? When you start working, it's a whole different world but enjoy your friendships, make some relationships, um, and enjoy your time in medical school cos you won't get it back. Well, Doctor Aaron, thank you so much for your time and that informative, comprehensive and quite sobering talk and not only discussing the problems that are currently affecting the system, but also something that we can do about that as well. So, yeah, we really appreciate your honesty and your time. Um, so I'll ask people in the chat to put questions in, so we will get to that shortly. Uh But before we do the Q and A, er, we're gonna take a brief uh, 5, 10 minute pause um, in which we'd kindly ask you guys to fill out a feedback form. Um So it's in the chat now, if you would kindly like to provide some feedback, um This actually helps us immensely with helping um you know, getting more doctors on board as well as rewarding, you know, speakers like Doctor Aaron for their time. Um So please take 5, 10 minutes and then after that, we'll circle back and do some questions. Cheers. OK, guys are back. Ok. Fantastic. So we've got some feedback forms and if, while we answer these, um, questions, if people are still writing them, feel free to send them off. Um, and I'll just have a camera and we can start. Ok. So I've compiled a few questions. We'll start from the top and work our way down and it's up to Doctor Darren's time and his discretion. Not sure how little he can answer if he's covered it already in the talk or if there's something more. So we'll start with one of the questions from and I think this is what people are referring. Sorry, I've got, I've written some questions now here because I wanted to just make sure that we weren't covering the same things. Sure. So let me just, just cover a, a few things and obviously if I haven't covered what you wanted to me to, to cover, er, we can, er, just, er, add that as a question. Sure. So first thing people have asked for is a l um, is it worth doing? Yes, it's worth doing ok, not just as a human being, uh, being able to save someone's life, um, on the side of the street, but it will make you, you're gonna need that as a, as a, as a bare minimum. Now, if you can do a LS, um, that's gonna put you in such a better position to be able to apply for jobs because it means instantly that they can put you as a bleep holder. Now, obviously, if you don't feel comfortable doing that, you can, you can report the trust and say, look, OK. Yeah, you know what, I've got my A LS but I would like a few more months on standard days, not nights just being able to hone my skills because I don't know the number for the cardio reg. I don't know the number for the recess reg. I don't need all these, I don't know how to order an X ray because all all systems are different. So B LS is a must. A Ls definitely worth doing. Now, one thing that I see a lot on um on Instagram and other posts is, you know, you've got some guy who's saying, oh come down to London pay 200 quid and I'll teach you how to stitch, don't do it. It, it's n no one's gonna hire you because you can, you can stitch. I mean, for goodness sake if you can't put in a cannula and do bloods who's gonna hire you to stitch? Ok. There are F ones F twos. You get graduates who don't know how to stitch yet. You learn to stitch when you're in those departments, like in A&E and even then you do it very, very rarely. So don't go and spend some money driving to London and paying for a hotel for two days for some guy who barely has as much clinical experience as you do. Ok. Who's made a poster Instagram post wants to charge you, er, er, 200 lbs, but they're gonna give you a sewing kit which they bought from China for two quid. Ok? It's not gonna hold any water. Ok? No one ever is gonna hire you because you can stitch. They're gonna say you somebody who's not managing their time and resources properly because if you can't take bloods and Cannulas, what's the point in doing stitching? So be careful. The court there is, there are some, there are predators out there who are just looking to get money out of your pocket or are looking to stroke their own egos. I'm sure that let you know, I've done a few of these lectures, not just for this society, but for other societies. I don't charge a single dime for any lectures that I give because as a medic being a me, being a doctor means something. Ok. It means not only are you responsible for your own learning but you're responsible for other people's learning as well. You, you pay it forward. Ok. So these people who are putting these courses together, um, nine times out of 10, they're doing it for either their own ego, er, for their own portfolio. But for you it's not gonna carry a single iota of, er, of weight. So, be careful where you spend your money and who you give your money to what I would recommend though. And I know some people have, er, they've done their, a lesser, which means that you're gonna be a lot more hirable because it means that the, the, again, always think about resources in the NHS means that you can do more shifts, you can cover more shifts, you can work more independently as opposed to having three doctors on a, uh, covering one side of a ward because none of them have got a LS, they can hire two doctors because one of them has a, has advanced life support. So, a LS, if you can do that, I would highly recommend it. It is difficult. Ok. And it's expensive. Many trusts will, will pay for it for you. Once you, once you join their trusts, there, there's a fund for that. But in terms of the current job market and getting into the job market, if you have a LS, it will help beat the bottle neck. So that's just covering A LS and, uh, and B LSS and all these airy fairy courses where somebody gives you a stitching kit nonsense. Um Someone asked about attachments. Ok. Er, attachments. Yes, attachments. Now, for whatever reason, I'm not really sure why are notoriously difficult to come about when we were undergrads. Um Obviously, if you have family and friends who work in medicine, you know, there's an avenue through there but that's, you know, no one wants to be a Nepo baby. Um um But yes, it is true, that experience and attachments are difficult to come, come by and that's why I say do it from year one and make yourself indispensable because if you can do it in year one, the chances of them hiring you again, the year after the year after the year after the year after is gonna be in is gonna just be uh a lot more uh potential for you to be rehired if you just go to that attachment and just sit there on your phone, twiddling your thumbs watching the clock. What time are you meant to go home? Uh I'm meant to be here until about 2222 30. Ok. It's 12. Now, do you wanna go home? Yeah, I'll go home. No, no, no, I, no, no, I'm, I'm here till two. II say if can I do a blood, can I, is there any chance I can do a cannula? They may not on the first day. They might not say yes. But by Friday they'll say OK. You know what? All right, you know what, if you do a good job, Monday to Thursday, Friday, I'll let you take that blood. Ok. So making yourself indispensable. Um, um, and doing attachments from the early years, building relationships from where I said that as well. So, you know, if you get into a hospital and you've got a personality, you're not a block of wood. Ok? Some of you guys have really, really, really got to raise your game up in terms of being professionals, ok? Some of you guys, I mean, I remember being in a lecture and somebody giggled because a pair of breasts came on, on, on the screen. These three girls were like he, he do this. A pair of breasts, guys raise your game, honestly, raise your game. You guys want doctors, ok? You're going to be on the same level as the UK graduates. Ok? So if you, you're laughing at a pair of boobs on the screen, maybe the medicine wasn't for you. So yes, attachments are hard to get to. Unfortunately, that's, that's just the nature that it is at the moment. I think there's some finagling and they're trying to have a more centralized um attachment system where as opposed to kind of before it could be informal. And now some certain trusts are moving towards more of a formal system where they're trying to have CBS and personal statements come in and have a department that looks at these and sees, right? Who's, who's the best person to, to give these attachments to? Because don't forget, attachments, people from year 11 are going for attachments. People from a levels are going for attachments. Ok? It's a much, much bigger field than you'd appreciate. Ok. So if you get an attachment, OK? Treat it like a donor kidney. Ok. It's the most important thing in, in, in the world and try to make the most of it. Somebody else said here, opportunities in Bulgaria ma make connections. OK? When I was in Bulgaria, I had a friend of mine who was a neurosurgeon. I have another friend of mine who was an American guy who graduated from M US. He's like working as a doctor. I made friends with him. He would take me in. Um I, I'm sure many of you knew that I managed to get a job at the British Embassy for 3.5 years. You know, when I, when I had my letter of recommendation, my references, you know, I had references from so and so, but I also had a reference from, from the UK ambassador. I had a reference from the Indian ambassador and a reference from the Irish ambassador from the American ambassador. Being in Bulgaria is what you make of it. Ok? You guys can have two options. You can barely go to lectures, go to seminars because you have to come home blaze play FIFA, go out in the evening, play some basketball and come on to bed and repeat. Ok? Or you can act like medical students. I'm not here to baby you. Ok, I got my job. I'm, I'm sorted. Ok, I've got two cats. I'm drinking Orangina. Life's good. Ok? But for you guys being doctors is not a job, it's a way of life, it's a way of thinking. Ok? Um, so you need to develop that. Ok, So if you're in a foreign country, you need to find those opportunities, no one's gonna bring them to you when I went, uh, when I started volunteering for the British Embassy and they created a position for me. That position had never existed in, in the past before. It's because I made myself that word. I keep saying indispensable. Ok. So they create a position for me. There, there are very, very few people who end up working for foreign embassies that don't go through the Oxford Cambridge PPE foreign office route. Ok. Who get direct hires while they're in country? Ok. I did that. Ok. And that, that means that you can do that too cos if I did it, anyone can do it cos I'm not the brightest, er, er, er, brightest bulb in the, in the box. Uh, trust me, I'm relatively thick. Ok. But I've got good work ethic and I work hard and that's half the game. So, uh, just so, you know, by the way I did no attachments at all. Er, but because I was a pharmacist and I was a clinical pharmacist in the NHS. That's why it helped. Um um for me, uh in terms of getting a job because my pharmacy job, I pushed into a clinical role. So I started becoming on commissioning and blood testing services. So, because I was running my own professional clinic, um, you know, I would pass an exam on a, on a Tuesday. I would jump on a plane, Tuesday night and Wednesday morning, I would be at work in London, we Wednesday until Sunday. I'd work Sunday. I'd fly back because I knew I needed the experience. I also couldn't, I had some um some property and stuff that I needed to, to manage. So I knew I couldn't afford to work for free. So I took my pharmacy job and I made myself indispensable. And through that I got the experience that I needed to get clinically. Uh Crest forms. Crest forms are the certificate for readiness of entry to specialist training. It's a form that you need to get signed off um at the end of your foundation training so that you can enter the M RCP exam, which means that um you can enter specialist training, right? I'm just trying to scroll through these Aaron. There was one question about how do you get experiences other than attachments? Are there such a thing anything that you would recommend? Yeah. So I end up working for a company called Good Shepherd. Good Shepherd. There's a charity run by, um, a Christian or organization and they provide halfway homes for people coming out of prison and people who are recovering from drug addiction and I would go and volunteer in those kitchens. Um, yeah, if you, some people did volunteering. Oh, I volunteered at my mosque. I volunteered at my, at my mother, I volunteered at my, er, my Goodra doesn't hold much, doesn't hold much water. You can volunteer outside your, your comfort zone. So I went and volunteered for a, for this Christian er, um, entity and it meant, you know, going through people's beds with these big l leather gloves. I remember I pulled my hand out once there was a needle stuck in the side of my, my arm like this in my, my hand, you know, soup in the evenings, going and talking and listening to them. Um, so experience doesn't always have to be, um, er, doctor experience. Ok. It's care experience. Ok. So working as an HC, a, getting jobs as HC A S er, simply volunteering in a hospital. Ok. And don't forget these things you can build on. Ok. With that famous word that I keep saying I indispensable, being indispensable. You come in as a volunteer and you're indispensable. Ok. And if you say, look, is there any chance I could maybe do a week, um, you know, um, you know, shadowing one of the positions. Guess what? That woman that you spent all week volunteering with? Used to be a retired consultant. Ok? Or is married to a retired consultant. She will say, hey, actually, you know what one of my sons is now consultant up in uh cardiology. I like you. You've got a good heart and a good brain. I'm gonna make a phone call for you. There are back doors, some of these back doors, you gotta kick in yourself. Some of them you're gonna make yourself, ok? Nothing's gonna be handed to you on a platter, I think. And that's one thing, a lot of people expect things to be handed to them. Ok. I know I was never handed any, er, um, er, accelerated opportunities in pharmacy. I made those, I was never handed any opportunity to work for the Indian or an American Embassy. II took those. I was never handed any, any experience, any opportunity to work for the British or Irish, er, er, er, embassies. I took those. I made those happen. Ok, so you're gonna make those, those happen yourself as well. There are always opportunities, there are community nurses, there are district nurses, there are home visits, ok. You know, if you go to a home visit where you're helping dress a category for sacral, uh, uh, ulcer, um, which is borderline osteomyelitis. Ok. It smells to high heaven. It needs to be debrided every single day by a nurse. That's some pretty serious stuff that's more serious than a cannula or a blood. OK? So you, you don't, don't always look for experiences that's happening in hospital. I'm not American Hospital all the time. No, their health uh the health environment is multifaceted, multi nichd. OK? So you can go to your GP, you can go to the volunteer services, ok? And once you get your foot in the door, you can build on those things, ok? Off the back of the, of the volunteering thing that I did where I was in the halfway house where I was, you know, going through people's beds looking for drugs. Um, off the back of that, I managed to ha to have a sit in clinic where I was watching them dose methadone. So when I applied for pharmacy school, they said, oh you've been to a methadone dosing place before? Yeah, I just spent a week just watching them do it. Ok. Good on you. Bang, take that one off. So it's what you make of it. Ok? So some of these things, you've gotta be a bit more aggressive as I say, nothing is gonna be brought to you. And now the market has changed significantly. So you've gotta up your games. Great. Um I've got a question which I'm gonna combine two people's questions because I think some of that out, um Jemima and kind of were both asking about your friend who immediately got a job as soon as they came um, you know, started working in A&E and I think that question also ties into how prepared were you, um, in regards to your knowledge and experience when applying, er, for a job at the NHS. Ok. I won mention her name because she's let me, sorry, I've got a bit of a cold as well. Sorry. Um, I won't mention her name but she was the, the archetypal medical student. She was in excellent health, was looked professional, acted, professional was a real go getter and, and worked her butt off. Ok. So, II mean it, it, we all say in our year it's a miracle that she didn't get into medical school. That must have been one hell of a competitive year because if you were to look in the dictionary, er, for the word medical student, you see her face doing this because she was absolutely on it. Ok. So she was, she went out every Thursday, every Friday, every Saturday. She had a great life at medical school, but she worked her butt off. She studied super hard. So she was very, very prepared and very, very comfortable walking into an A&E position cos I quite honestly would have pooed myself but she was ready, she talked to talk and she walked the walk, my first position was acute medicine. So, er, it's an extension of, of um, you know, A and EAA U and then up to the wards to the acute medicine ward. So, we can do some more, um, investigations. Very high paced. Um, terrifying, absolutely terrifying. My first day I didn't know what the hell was going on if you kn does anyone here just say yes in the comments section, know what a Sarah's steady is a sed, is a device that you help. Old people get in and out of bed. Ok. It's like a big frame that they wheel to the bed and the old person grabs onto it and they pull themselves up and then there's a plastic seat that slides in behind them and then they can sit back on this little plastic seat and then you can wheel them around the hospital, well, not the hospital but wheel them to the bathroom, wheel them to the, er, um, er, toilet wheel them to go and watch some TV. That, that system is called a Sarah. My first day I thought Sarah Steady was a person. So I'm looking around like, er, bro, do you know where, uh, where's Sarah's Steady? And he was like, what I said, where's, er, this? Everyone's asked me for Sarah's study. He went, that's, it's that equipment over there and I went. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah, of course it is. I had no idea. I had no people were using acronyms that I've never heard of before. People say. Oh, this guy needs a kilt. He needs a, what? A kilt? Like a kilt. Like you like what a squats man wears. No, a kilt. It's, that's a form that we fill in to get them, uh, home in a specialist ambulance. I'd, I'd, I didn't have a clue. I didn't have a clue. I learnt a lot in my first week because I kept my ears open. The other gateway doctors who were on my ward were like at, at 459 were like 54321 and I am out of here. I was staying in the hospital until 89, 10 o'clock. And, and you know why, I'll tell you why, because you can't sit here for one second and say, you know what, I've got no, not enough clinical experience. And then when you're working in a hospital where the clinical experience is for three, you're gonna go home at five o'clock. I wouldn't go home before 789 o'clock. And that's why every rotation that I've asked for since. So you do a thing called a tab at the end, at the end of every ro rotation, you do it once a year and it's, er, a form you send out to 15 people in the ward from consultants to the ward manager, to the matron, to sisters, to nurses, to the lower level staff and he, it's 15 forms out and they get back in, I got 10 out of 10 across because I went the extra mile. So for my next rotation, I could choose my rotations cos I performed, they like this guy knows what he's doing and he's prepared to put an extra mile. So, um, yeah, you've got to, you've, you've got to be aware that there are deficits that we have. Ok. And we need to be able to fill those deficits in. And as I said, for myself, I didn't really know enough. But luckily I had a good work ethic, I could fill those gaps in this other girl. She worked, worked, worked and she worked as hard as any UK medical student. That's why she walked to A&E like this. Thank you. Um I'm gonna combine another question from um Adam and Ria, er, and they asked about uh did you do any research or in while you were studying in Sofia? And also do you have any further advice for how one can develop the clinical or practical skills while they're here? Yeah. So II did a research paper. Uh I was lucky enough to get approached by a group of doctors from Czech who were doing this European wide study, er, about the satisfaction rating for um er medical schools around Europe. And they needed somebody in Bulgaria and somebody from Romania who had helped on a similar kind of thing, like a lecture like this. Um um I had mentioned my name and so they wrote to me and said, look, can you be the Bulgarian data analyst? And I was like, yeah, sure, I didn't, I didn't actually look for it that, that came looking, looking for me. But there are plenty of universities every summer in the UK who are looking for research people and no one is saying that you need to discover a new planet. OK? Or a new type of micro DNA. OK? It can simply, and my, you know, the research that I did research, I was just punching in numbers, I was questionnaire came out, questionnaire came back in, put those numbers into a database and I sent the data off to the guy who was doing the actual research, but I got my name on that research paper. So every university in the country I in summer when all the students go home are looking for people who can help do that basic level of, you know, it can be number punching, it can be some small cystic ana analysis. Don't forget when you do a research paper, it's, it's, it's um it's tiered, OK? At the top, you've got the, the professor below him, you've got the phd students, masters students, you know, um um undergraduate students and they're all looking to, to um to build on this layer cake. So the guys at the top are the ones who are presenting and going to uh conferences and have their name on the paper. The guys at the bottom, the undergraduates, they're just, they're doing the number number um the data entry, but it doesn't matter. You're still on that research paper. Thank you. Um Another question was from, it's the quick question it was um from saying I missed the part about the Gateway Foundation uh fellow fellowship program. Is this pathway still available to Eu Yes, it's still available to EU grads. Um I think what's happened this year because so in, in the hospital that I work at, there's a, there's a particular group of doctors who have done so badly, it's actually been dangerous. Um freezing when it comes to emerged situations. Scr I, we had one doctor who stood in the middle of a ward and screamed fecal, vomiting, fecal, vomiting, fecal vomiting is a very, very serious thing. That means you're puking your own feces. Ok? Don't need to be a doctor to understand. Mm. That's probably not a good thing. So when a nurse and myself approached her and said, where's the patient she went? I don't know. I said, what do you mean? You don't know? II A nurse just told me about fetal vomiting. He said, have you been to see the patient? She went? No. So Linda, let's go. Let's go see the patient. We went to the patient. I looked at the vomit, I smelt the vomit. I asked the the patient what she'd had for lunch. Half an hour ago. She'd had minced lamb and gravy. That's what it was in the bowl. No, from a trust point of view. That is terrifying that a medical graduate from a university can stand in the middle of a ward and scream at the top of her lungs, fecal vomiting without even seeing the patient. Another story, we had a, a gateway doctor, nurse came flying into the room. Er, doctor, can you come, the, your patient's got a, uh, um, a blood glucose of 1.2 doctor went ok. And she just turned around and started typing on her phone. I was sitting next to her and I said, I said, who are you typing? So I'm telling, I'm just letting the consultant know. I said, what are you gonna let? Tell him know, go and see the patient first, go and see the patient go and do your ABCD E assessment and then he'll, he'll have something to, to tell the the doctor she uh ok. Sat there still typing nurse came flying in again. Can someone please see this patient? They're becoming unconscious. So I leapt up, grabbed AAA Big Bolus of glucose ran to the patient, put it into her arm. Guys, I need a 20 minute blood glucose, please. So that got reported that there in our hospital, they, they, they're called dayes. A dex is when something goes wrong. Ok, I've had no day taxes. One doctor on the gateway has had 51 has had nine. Ok. These are terrifying incidences. Ok? They can't fire them because they're in a two year contract. Ok. But what they can do is prevent them from going into F two because they know that wouldn't be allowed to look after patients by themselves. So, what I'm telling you about the reputation of Bulgarian doctors. That's the kind of stuff I'm talking about. Ok. This is another one as well. I get a phone call. Have you seen? So, and so doctor I said, no, I haven't seen them. Ok. If you see them, let us know, put the phone down. Where did go put in a cannula? Putting in the cannula? This gateway doctor came up to me, one of the ones who is not performing very well and said, do you think she'd be murdered? And I said, excuse me, she went, do you think she's been murdered? I said, I will talk to you in the office after I put the cannula in. So she went back, I put the cannula in, went back into the office and I said, what the hell's wrong with you? Www Murder? Why? Why can't nobody find her? I said, how often can you not find a doctor in a hospital? He said it happens all the time. Where have you, where have you gone from? Can't finding somebody to being murdered? And even if you think they'd be murdered, don't come and tell me in front of a patient guys. That's the level of unprofessionalism and sheer stupidity that some of the Bulgarian graduates are exhibiting. And that's just in my trust, that's one trust. So the reason the gateway programs are so difficult at the moment to even get, even get a phone call answered by them is because they're pulling out left, right and center because of situations like this. And I'm really, really sorry and I'm angry and I'm, I'm trying to work with um, the Gateways er, program now that they put me on, on as an ambassador now to tailor make the program and say, look, you know, guys, this is what we need, this is what we don't need. You know, we need like a whole week of taking blood, a whole week of doing Cannulas er cos if you can do blood for a whole week or a whole cannula, you've got it. Trust me, it's not, it's not that difficult, but that's why the Gateway program now is, is so, so difficult. It is still open. I just think that a lot of trusts are pulling back because of these horror stories that you three examples. I'm just giving you now. Wow. Um sounds quite harrowing. Um I'm gonna keep it to the last two questions now because Aaron you've been more than generous with your time already. So we'll give it to um GK who says, what special would you recommend for clinical attachments to get the best practical and clinical experience in any? Doesn't matter your, it, the specialty doesn't matter at your level if you're working in cardiology, stroke hematology, elderly, it doesn't matter as af one you're doing the same jobs. Ok. So you're not gonna be, there, won't, there'll be any difference to your job. Really? As, as the attachment, elderly is very, very good because they often need lots of bloods and lots of cannulas and there tends to be a lot of positions in elderly, but in terms of which departments are the best, it doesn't matter at your, your level. Your, that's like us telling a waiter. Uh, hey, which restaurant is a uh? Oh, sorry, er, er, um, say cleaner in a hotel? Hey, which hotel is the best to clean? It doesn't matter. I'm still cleaning up. Shit. It doesn't matter at that level. It doesn't matter what department you're in. Don't, don't focus on that, just focus in getting an attachment and once you're in that attachment, work so hard if that consultant doesn't know your first name by the end of the attachment, it's been a waste of time. Ok. And when you know that attach, when you know that consultant knows your first name, make sure that you know what his birthday is. You send him a message at Christmas, you know, you keep that relation going cos y you know, you're gonna ask him, hey, you know, in April any chance and it doesn't have to be a whole month. He might say actually, you know what, in April, I can probably get you in for a week So when you get an attachment, respect it work as hard as you can because even if you rotate in the same department for five years, ok. Every summer you come back and do the same attachment. This girl that I told you about who, who ended up working at um six weeks after graduating er in A&E er she did three of her attachments in the same hospital in the, in the same department just because she made herself magic word, indispensable, brilliant. Um, and so we're gonna end on this question now. But guys, if you have any more questions, I'm sure, um, if it's ok with doctor Aron, if you've got an email address or a contact people can reach out to you. Oh, that would be fantastic if you could put that in the chat. Um, but the last question that we have now is it's from Honey Matthew and it goes, uh, what ha so what happens if you have done all the things that you've said? And there is still no prospect of the job? Ok. So this, this is, that's an excellent question. Ok? If you reach for the stars and you fall short, you're not gonna come up with a handful of dirt. Ok. What I mean by that is that you've got to stay positive. Ok. And this is one of the most difficult things to do is when you got pressure from your parents, why haven't you got a job? Yet. Why, why is uh why is your cosmo working? Why? No, no, no, no, no. Uh it's, it's difficult because you're keen, you want to start working? Ok. It's, it's for my, my pathway. The gateway, you know, II told you II finished in December 22. Graduated FEB 23 GMC April 23. 1st job in August 23. Now, up until two weeks before I started my job, I didn't have a job and I was down and I was depressed and, but I tried to remain positive and focused and not give up. And within two weeks of Gateway ringing me, they said Aaron, can you do an interview tomorrow? II was like, yeah, ok. Uh I, I'm a, I've got a, a job somewhere but I can do it from the car park. They said not a problem. I into the next day in the car park, they went fine. Can you interview a week from now? On two with the trust? I was like, ok, but I'm at work. Um they said fine be from the car park and then four days later I was working. So in the space of hearing nothing, hearing nothing from, from when I got my GMC registration. Within two weeks, I'd interviewed Gateway, interviewed for the trust and then I started work so it moves, it moves very, very fast. Ok? But you will not find it easy to get a job unless you are prepared to get those attachments and those attachments. There are official routes. There are unofficial routes. You can write to a cardiologist, you can write to somebody that you're interested in working with or the, you know, you've gotta be brave. You. No, this isn't, this isn't G CSE where your, your, uh, your teacher gives you all the, all the past papers and then you, you learn the past papers and then you go into the exam, ok? This is real life now. Ok? So you write a letter well written, ok, that you can reproduce. Dear doctor, leave that blank. So you can put a doctor's name in there and send these things out, ok? If you want a fish, ok, you've gotta have some bait, ok? You can't just lie inside the river and the whole fish are gonna fly up out of the water, open to your mouth, ok? You gotta put one rod in, you gotta put two rods in, you gotta put three rods in the more rods you put in the higher the chance of catching the fish. But like I said, no one's gonna bring it to you. That's perfect. Well, Doctor Aaron, I speak for myself and everyone here. Thank you so much for your time and for your er, really prudent sage information about how to get jobs and what the current state of the market is at the moment. Um, like I said, if one of our colleagues has put the link to your chat in the er, in your whatsapp group in the chat. So if anyone wants to go and join, please feel free. Um I send a big thank you for myself and everyone to doctor Aaron for his time. Um Before everybody goes, if you could kindly make sure to fill out those feedback forms um as a matter of urgency just so we can get them all um sorted. Um and also, er, if you follow us on Bim dot BG Instagram account for more up to date information about further talks happening too or if you have any further questions, a gentle reminder, we have another talk lined up on the 21st of October. Um, it's our Ielts and O ET talk. So the language exams that we all have to do before we finish. So if you guys are interested to follow us for more, er, actually, er, guys just, just one thing about that. Ok. Um I've, I've put my phone number into the chat. Ok. Now I will, I'll try and confirm this this week. Ok. But don't sell the farm yet. But apparently the GMC have written to one of the students in our year informing him that you no longer need the ielts or the O et don't sell the farm, ok. Don't open the champagne yet or sparkling rose, whatever you have in. Ok, let me confirm that first. Ok. Cos it sounds a bit. Mm. I'm not entirely sure if that's true. But this guy said that he has a bona fide email from the GMC. I've got a GMC phone call tomorrow, um, at my phone calls at 1145. Ok. So whatever, er, I get back from the G MCI will get it in email. Ok. I say guys thank you for the information. I need that official because there's people who are, who are, er, um, who need to know if this is something that, that, that they no longer need. So I will get that for you by tomorrow. Ok? And it'll be rock solid. Brilliant. I look forward to the news doctor Aaron. Thank you so much for your time, everyone. Thank you so much for joining as well. Ok guys. Thank you everybody. And uh as I say my, my phone number is in the in the chat. Er if you guys need to talk to me, let me know. Thanks a lot. Take care. Thank you.