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BIMA: CAREERS IN CRITICAL CARE AND RESPIRATORY MEDICINE

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Summary

Join our exclusive on-demand teaching session featuring esteemed Professor Sabir Singh. A respected consultant in respiratory and intensive care medicine, Professor Singh brings his wealth of experience from the Royal Brompton and Chelsea, Westminster Hospitals, and Imperial College London to this insightful lecture. He covers an array of topics from his personal journey into respiratory and critical care medicine, to practical tips on patient interaction and decision-making. He also emphasizes the importance of adaptability, passion, and communication as a medical professional. This interactive session provides an opportunity for attendees to ask questions and engage in insightful discussions, making it an enriching learning experience. Whether you're a budding professional or a seasoned medical veteran, this lecture is a valuable resource that will surely enhance your medical knowledge and professional journey.
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Description

A career talk into critical care and respiratory medicine, delivered by Professor Suveer Singh.

Professor Suveer Singh BSc MBBS PhD EDIC DICM FFICM FHEA FRCP is a consultant in Respiratory and Intensive care medicine at the Royal Brompton and Chelsea&Westminster Hospitals, and Professor of practice at Imperial College London.

He has clinical, teaching (UG and PG) and research roles in both respiratory and intensive care medicine equally.

He is senior editor of the Oxford Textbook of Respiratory Critical Care. He is also President of Imperial Medics Critical Club.

Learning objectives

1. Understand the importance of adapting to changing circumstances and being open to new opportunities in a medical career. 2. Gain insights into the process of pursuing specialization in a particular medical field, using the speaker's journey into respiratory and critical care medicine as a case study. 3. Internalize the importance of passion and commitment in medical practice for both patient care and career advancement. 4. Understand the significance of mentorship and supportive work environments in fostering professional growth. 5. Learn about the balancing of clinical training and academic research in one's medical career, as demonstrated in the speaker's experiences in undertaking a PhD alongside clinical practice.
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Computer generated transcript

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

Um Hi, everyone. Am I being heard? Ok. Um I think we've got our speaker in Professor Sabir. So I think we can start the right now. Um Yep, let me just write this stage. And Professor Singh, are you able to um are you, do you have access to the slides, access to screen sharing? Yeah. All right. Um um While we're waiting on, you know, the slides and everything, I'm just going to do a quick introduction for Professor S. Um He's kindly agreed to help speak today for us. Oh, hi. Hi. Hi there. Um And so Professor Se Singh is a consultant in respiratory and intensive care medicine at the Royal Brompton and Chelsea and Westminster Hospitals. And he's also a professor of practice at Imperial College, London and he's got loads of clinical teaching and research roles in both respiratory and intensive care medicine equally. Um He's also senior editor of the Oxford Textbook of Respiratory Cri Critical Care and he's also president of the Imperial Medics Critical Club. So we're very lucky to have him here today to speak for us. Um And the stage is all yours. Professor Sing. Thanks. Um uh Thanks. Very much uh for the invite. Now, I'm uh I'm actually interested in uh making this interactive. Um because in a sense um I can do a number of things, but I'm really interested in, in what your audience, what your um uh colleagues uh really want to know. Um So we should use the chat as much as possible. Uh Um And I'm happy to answer some questions. Um but maybe to, to kick off, I will uh just give you my route into respiratory and critical care medicine. Um And uh first off to say that um uh whatever you want to do in your careers, um you have to be uh clearly passionate about. Uh and you will, you will obviously have a, a first uh plan uh your a choice. But remember the way that we study and practice medicine and indeed in our professional lives and indeed our, our um uh nonprofessional live, you know, we're very committed, motivated people, we're able to adapt and we can do pretty much anything that is thrown in front of us and that applies to clearly to all of you. Um So whatever you decide to do, um even if that doesn't work out with your plan, a, you've got every uh chance of being successful in what you do. Um As long as you commit yourself to it, uh look for opportunities and uh you know, abide by those um uh those principles of being a good doctor, right. Um But let me uh you know, with that said, let me, let me spend a few minutes just explaining what I did. Um So um uh during medical school, I wasn't really sure what I wanted to do. I didn't have a grand plan. Um I enjoyed pretty much most of the attachments, the clinical attachments that I did. Um And um uh as a house officer equally, I was not really clear. I, my first house jobs were in respiratory medicine at a uh at a big uh teaching hospital in London that was uh very uh very stimulating, you know, being around um people uh who were uh excellent clinicians, uh they were excellent communicators. Um And very interestingly, I just recall 11 story which was um the first time I saw uh or I was involved with the patient who had a cardiac arrest. I was on the ward. I um the patient was deteriorating and I um uh took some bloods and so on, called for help, went off um to get some bloods. And by the time I'd come back, the patient had had a cardiac arrest and the uh the arrest team were there. And um I felt as if it was my fault that um that patient had deteriorated and got worse. I don't know why. Maybe it was the fact that they got worse as I was going away to um uh uh to, to uh take some investigations to the lab as an urgent. Um, but uh, when I went for a debrief with my consultant, it, it was, it was very eye opening. You know, he was incredibly reassuring. Um, the first time that happens to anyone, uh, you know, you, you start to wonder about what you did or what you didn't do, uh, that may have influenced the outcome in a more positive way, but actually being able to um reassure people uh when there's uncertainty is a really important part of um your roles and you know, when you, as you, as you through the ranks, uh being able to support those uh below you and alongside you uh is, is really important and it's uh it's very motivating, not just for them, but it's, it's motivating for you. Um Because that's such a crucial part of development um uh beyond simply your uh your clinical skills uh and your competencies. OK. Um So, um so carry on the story, um I thought I wanted to do medical ophthalmology, very specific. Um You might say, uh and um I pursued those goals doing neurology, neurosurgery at the big um centers in London. And then, um I uh uh then uh went on a, a course in Oxford um uh regarding ophthalmology and uh did a few um um uh uh sort of won a few prizes, blah, blah, blah. Um And it was a, it was a period of time where there was incredibly, er, it was very difficult to get into ophthalmology. There was an enormously tight roadblock getting into that specialty. Um, and, uh, that didn't really bother me but, um, I decided that I wanted to do, uh I, II decided that II sort of ought to do um, intensive care medicine because I would never do it again. Um, this was, I think I was, I was a senior sho, I just passed my membership um M RCP. Um And uh I thought, OK, look, let's do this. And I got a uh a competitive job at the Brompton uh through interview in those days, you know, you had to interview for each job. And I thought, wow, this is great, you know, uh I, I'm, I'm at the bro. It's, it was well known then as it, as it is now internationally round place. Um The teaching was excellent. The um uh the people, even though they were, you know, professors in every corridor, they were, they had a humility and there was, there was an air of learning around it and that's not the only place where you can get that vibe, but it was, for me, it was, it was great. Um We, yes, chosen those days used to be called the Lost Tribes. Um And II think to a degree, it's, it, it hasn't really changed even though the terminology for the grade of doctor you are um in those, in those sho years you know, between your foundation years and first foundation year and then, uh your, uh training years, uh specialty training years. Uh, they're formative in many ways. Um uh, but you don't fit into the, uh, the focus of the, the uh preregistration foundation, your doctor, uh, in the sense of the, um, the money coddling to a degree that is done. Uh, and you don't fit into the specialty training, uh pathways that um, uh then focus on your, you know, your particular interest. So, anyway, so that was, um, that was, uh where I was and I, and I got there and I chose, uh we had three month blocks. One was uh in uh pulmonary medicine which I did um, uh a cystic fibrosis job. And, um, uh, and then the other one was intensive care medicine. And, uh, and my first few days on the, on the, uh, the IC were I II was completely lost. Um, you know, you had to read out, um, uh, you had to read out the, um, uh uh the, um, pulmonary artery catheter readings for each patient. This is a cardiorespiratory um unit. And, um, and it was essentially reading numbers and I really didn't have a sense of what that was and even my presentation was pretty, pretty dire I would say. Uh, and, um, and then one of the senior registrars, um, pulled me aside one time. He said, look severe. Um, you're, you're doing, you're trying uh really well. Um But why don't you just present the patient as you would imagine? You know, if, if you were on the ward without, without all the numbers and all of a sudden there was a light bulb moment, it was um, ok, so this is a patient who has come out of surgery and effectively he's got heart or she's got heart failure, uh left or right, heart failure with organ dysfunctions. And uh and here are the numbers attached to the, the monitoring and the systems so that in a sense, developing a systems approach and an organized structure that was based around what I was used to and was good at in terms of clinical uh medicine. Uh all of a sudden allowed me to um to start to develop an interest in this. Um So I did that and uh I went on this uh this ophthalmology course and um was intending to apply for ophthalmology. And then at the end of that, um the, the Professor of Pulmonary Intensive Care Medicine, the, the late great um Professor Tim Evans um came up to me and said, and interestingly and slightly ironically, he'd, he'd signed my um sort of reference for applying for specialty training in ophthalmology. And he came up to me and said, um quite funnily, you know, he, he, he would call all his, his young fellows and people, son or ma yeah, he'd say, son, what are you? What are you doing for the next three years of your life? I said, well, I applying for and then he said, um, do you want to do a phd? Uh And that was a real, uh that threw me actually because I was thinking my goodness, not only um uh is he offering me something uh in a different specialty? So call me in critical care medicine. Um, but I'm, I'm gonna be taken out of clinical training, you know, where I'm comfortable and I'm, if you like at the height of my powers at the moment, um just having done my membership. Um and um and I went away one weekend and I said no. So and then I thought, what have I done? I've, you know, I've just um annoyed uh the, the first professor of intensive care medicine in the country because II don't want to do that or I don't think I want to do that. And he said um just go away, think about it. Um No pressure. Um and we can um we can have a talk about it and he was fantastic. And then I thought, and I, and, you know, really um weighed it up. I said, hang on. Um I'm at Brompton Pulmonary in er Respiratory er, and Critic Care Medicine. It's a, it's a center of learning, it's a center of excellence. I'm being offered a position here for three years um with a funded uh phd. Uh I kind of enjoy it. So why wouldn't I do that against, um, what my original intentions were, uh, but which may still be a, you know, a long route without any guarantees. So, I, that was my, um, if you like light bulb moment and that's when I, um, uh, that's when I sort of signed on the dotted line and, and never looked back actually, although there have been a few interesting, um, er, decision points along the way. Um So then II got into the phd programs, Clinical phd at Imperial, I was um doing uh respiratory medicine clinics. Um I was um working on the ICU developing my skills there and doing academics as well. And as part of that, that was um there was quite a bit of teaching involved as well of, of medical students. So that was, that was great, absolutely, thoroughly enjoyed it. And um and what it then allowed me to do was to enter if you like another, another avenue that II personally have not looked back on, which is um the opportunity to do clinical research and some basic research alongside um uh clinical activities. Um and, and to, and to do teaching as well. And um through the years I've, I've been able to split my um uh my job plan if you like between 50% respiratory medicine from a clinical perspective where I do sleep and ventilation clinics and general respiratory um and uh and intensive care medicine at uh two places as it happens. And that's a little unusual but uh the, the cardio Respiratory Specialty Unit at the Brompton and also a General and Burns. I see at the Chelsea and Westminster Hospital all as part of Imperial. Um Along the way, I got the opportunity once to uh I was offered um the position to become uh the second in command if you like in the interstitial lung disease Unit at um at the Brompton. But it would have meant a a and that was a hugely prestigious uh um post, uh an unbelievable opportunity. Um But they weren't able to find a way of uh enabling me to carry on doing intensive care medicine. Uh Alongside that, the irony is, you know, that was uh 15 years ago, um um where that wasn't really considered um something to do and yet now in uh pulmonary and critical care medicine, it's now almost established that you will do uh some respiratory and some critical care uh often in the same place. So, uh so that, so I carried on doing what I was doing. Um And uh and whilst it's been, it tends to be busy, the risks of doing something like that, that you are seen in a slightly different light uh by the alternative specialty. So you're maybe not considered a full quick care physician by the um the ICU folks and vice versa. Maybe you're not considered quite in the same light by the respiratory physicians. Um, but, you know, in a sense that's, that's entirely up to them. You, you can, you can do excellent work in, in, in both fields and it's just, it's just hard work. And then when you add, when you add on to that, the opportunities to, to do research again, you have to find time for that and, and, and the reality of the situation is that either you are on an academic path where you are funded and apply for grants to uh to buy your time effectively, or you have to somehow cobble uh money together through, through grants and create time for yourself and your, your fellows and so on. Um And I've followed that second pathway which is uh not easy, but uh but you can still a great lot of P and success in uh with BSE students, with master students and MDP PhD students and the like, it just, it's just not easy to do. So. Um So, so that's really where, you know, that's where I got to in terms of my pathway. Uh sometimes, you know, serendipitously, um you know, I, if it wasn't for me having thought, oh, I better just do IC because I'm never going to do it again. Uh And I'm at a great place, then I, you know, I may not have actually um pursued that at all. Um And similarly, if I had worked in certain places, um and actually been bitten by the, um, the bug of teaching, learning, shared learning, um, and interest in, you know, the, the research question and what that, what that might bring, uh, then I wouldn't have been where I am and I thoroughly enjoy it. Um, and, and the other thing to say before I stop and you hear comments and listen to questions is, um, uh, you never stop learning. Right. I've just finished a year long um uh online certification course with Harvard on, on clinical research training. And I've been relearning some of the things that I thought I understood, but I really didn't in terms of epidemiology, biostatistics, coding and so on. And that I think has helped me and I hope it will help some of those um uh that I teach uh particularly on my BSE and, and, and, and, and sort of teaching um research courses uh to help them. So, um what you have in front of you is a um uh a clean slate, a blank pallet. And um uh it will be interesting for all of you to see where you decide to go. Um But in terms of what is great about uh pulmonary and critical care medicine, what I found it to be great is that um uh there's an enormous diversity of what you can do within both specialties. Um and they are very aligned and um my uh the book that I've um edited the Oxford Textbook of respiratory critical care again, gave me an opportunity over quite a few years of doing it um to really um uh link the two of them and it, it, in a sense for me was AAA current combination of the justification of, of how those two are in inextricably linked. Um So I'm gonna stop there. Um That's just one person's journey so far. Um I'd be interested to know what uh what others might want to hear from me. I do have a few slides but um um I'm happy to show them as, as you wish me to, I'll stop there. Thank you so much for that. Um We can take questions via the chat if um if anyone has any questions that was really insightful, by the way. Thank you so much. Yeah. Pleasure, pleasure. Um I'm just looking at where um if there are any thoughts, any questions um about um the pathways um about uh tasters. How do you get a sense of whether you're going to like this or not? Um a a and, and I'd be interested to know given that some of you will be from many different universities, what your exposure to uh critical care is and what you obviously the exposure to respiratory medicine will be part of your clinical firms. Uh But I II suspect that it varies quite, quite a lot in terms of um acute care and critical care. Definitely. If anyone has any thoughts, please feel free to share in the chart as well. Um I think personally just, um I'm currently a foundation doctor in my first year. But um, in university, I think we had quite minimal exposure to, um, I think critical care and things like that. Um I think we barely just had about 2 to 3 weeks in the ICU but um it was very eye-opening. There's, you know, loss of things that you don't see in other medical specialties. Um obviously, but it does seem very overwhelming as, especially as medical students seeing, you know, how we meant such critical patients. Yeah, for, for sure. And, and, and certainly it's um you know, II think there's a lot to be done about how to engage that specialty with um uh with, with me students. Um you know, we, we like a, a number of places have created um uh some online learning tools um uh case based discussion is always a good way to understand anything. But also it's a, it's a lot of it is around um clinical decision making and, and um if there are tools or opportunities to be able to uh discuss why um certain decisions are made, how judgements are made in the, in the face of diagnostic uncertainty that I think is a really important aspect of critical care. I mean, medicine in general, but certainly in critical care, there is a complex environment, there are, you know, risks and benefits to every little thing that you do and trying to organize that into a structure and to be able to get that across, I think is, is one of the things that we should do better. Definitely. Um Thank you for that. Um I think just um generally, would you have any advice for medical students currently, you know, that might be considering going into critical care, what they can do as medical students, what opportunities they should look for? Sure. Um So, um so what, what you often need is uh is someone who will engage you, right? Um You need someone to provide you with the spark uh that might um that that might make you think. Oh, actually, this might be for me. Um uh And I think that, but I would uh I would always suggest that you try and link up with one of the, the registrars, the ST S um or the fellows um uh because they will um in a sense they're committed to it, right? And so they will give you um a, a clear review of the pathways. Now, remember the pathways for getting into uh that, that specialty um after your um uh core medical training, um it may be through anesthesia. That's certainly the the biggest pathway. Um But uh but it could be through pulmonary medicine and then, or it could be um single stream critical care training. Um I would always say that um if you, if you can um uh you should try and do dual specialty training. OK. Um It just gives you more opportunities. So um yes, it does extend your training. Um But then you have uh not just a fall back but you have that diversity of interest um to be able to um switch between um uh the two sets of uh clinical domains. But also you get to interact with different groups of people in different networks and that can be very um very positive in anyone's development to be able to have conversations at a specialty level and then to bring back those conversations into your other interests into your other clinical domain. Um I found that to be II found that to be very interesting throughout um but particularly during COVID where um you know, from a, from my perspective, I was seeing patients in clinic who had cough and breathlessness, they were then getting admitted to hospital where I was admitting them in the A&E for instance, um they would then go on to the respiratory ward for their CPAP or their N IV or their high flow and they would, some of them then would end up on the ICU where I was um then working as well. And then, you know, those who survived, I run the um the ECMO and a follow up clinic at the Brompton. And then, you know, those people would come back into my clinic. So in a sense, I saw the whole pathway and that was really interesting. It gives you different perspectives. I've got, we've got some, uh, um, questions here. Uh, hi. Will it be a recording mate? Um, I hope so. There is a recording. Uh, so, uh, Nikita Wright. Hello, is a, uh I MG junior doctors who just started in the UK, had less exposure to the medical system here. Um, would you say that the main thing should be, uh, what would you say is the main thing we should be looking out for or give priority. Um So, uh first and forth and foremost, Nikita, um show your enthusiasm, show your interest, develop an interest, you know, just ask lots of questions and get good at your presentation skills. Um And it's very easy for, for people to pick out someone who is, who is enthusiastic and, and interested in, in what they're doing. And that just uh opens doors without you even knowing, you know, it's, it's very easy to see people who, um you know, are interested, are putting, you know, AAA good shift in. And I say to my junior doctors uh right at the beginning of my shift, you know, I say to them, um what is today? And, you know, they look at me confused and uh they'll give me the, the, you know, the name of the day. And I say um today could be the best day of your lives. And, you know, I say slightly tongue cheap but the truth is there, right. Um uh You start off the day, uh the clinical day uh with that positive, well, what are we going to learn today? And at the end of the day, if you can even to yourself to just think about one thing that you learnt that day. Uh Hopefully it's something medical, but it may not need to be something medical, but you start the day with that. What am I going to find out today and finish it with? What did I find out today? And I think that will hopefully take you um take you a long way. Um Other uh other questions or queries. Um Just maybe while we wait for any other questions, if you could just explain a little bit more on the dual specialization that you were talking about earlier. Yes ss. So, um you know, when you uh after this, if you get a chance to just look at um how to, um you know, you can search how to um our careers in uh respiratory and critical care medicine. Uh And then you'll see, you'll probably need to go to careers in critical care medicine and you'll see that uh the um the pathways uh for that um uh A and, and you'll be able to see what uh what opportunities um there are. Uh so, uh um and the um uh the websites to go to, obviously you can go to AE um uh in uh the health uh the Health Education England um portal or you can uh look on the f the Faculty of Intensive Care Medicine uh website. Uh And um so here's uh let me just see if I can share this for you. Um uh It's just uh no. OK. Uh um Let me see if I can share this. Uh Yeah. Uh So that's the, um that's the Faculty of Intensive Care Medicine uh careers. Um, and, um, so that's, you know, that's a, that's a great opportunity, you know, stories from Im GS ICU Post for Im GS. OK. Um, that's workforce. Um, and then there are links on training, curriculum and assessment trainees, um, uh, uh, et cetera. So there's, there's that, um, and then if you, um, I, if I now just share something else with you. Ok. All right. It's just, uh, yeah, window. OK. These are, these are just, um, a few slides I'd, uh, I put together, uh, just tell me if you can see this moving forward. Yeah, we can see the slides move. Yeah. Ok. So this is, uh, slightly tongue cheap but, uh, you know, it means different things to different people, you know, uh, intensive care. Yeah. Um, uh, yeah, there's excitement. There's glamour, it's saving lives. It's a worthy human endeavor. That's a typical morning, the 8 a.m. rounds. Um, although oddly we don't wear white coats anymore, which is a real shame. Um, highly skilled staff. But in the end, it's still about sitting down having a good cup and thinking this is the handover. The handover is such a crucial bit of everything that we do. And it's, it's really important that you engage in that. Well, because that's where the transfer of the most important information is. Um And you've got to prepare for the challenges of the day, you know, highly skilled staff from a whole range of backgrounds, um fellows different specialties. Uh And there are some strange people um in critical care medicine as well, some super geeks. Um but you know, very motivated staff, the nursing staff are amazing um always ready for action. Uh And they all have one aim you get calls. Um and, and you know, you have to juggle your life. It's a busy specialty. Ok? Um and uh uh you have to go and see patients uh you know, who are sick wherever they are and you got to deal with the unexpected. Yeah, it's uh otherwise known as the department of expensive care medicine. Um and you can only really discharge patients when they're clinically ready. You're, you're constantly, I think it's as is the case of uh most specialties uh under the cost in terms of um occupancy rates, you know, there, there's always a net inflow into uh acute care specialties. Um So, uh yeah, you can be satisfied you satisfactory episode. Um and you have to, you know, end of life is a really important bit and you have to, you develop your skills in that and become better at it uh through listening to others and sometimes you, you get it wrong. Um But, you know, you do have time to unwind as well and there are great opportunities and I've alluded to a number of them and, you know, these are the clinical tracks, whether you're doing respiratory medicine or ICU um that you can think about, you know, and these are the things that one would rotate through the different specialties, you develop procedural skills. I'm doing some international work on bronchoscopy and intensive care and to try and improve standards there. Um And uh you know, research can be basic size, it can be audit, it can be um health related outcomes. Uh People go into management and there are various management courses um you know, at different levels of your um of your careers and again, high high degrees education and that shared learning approach. Uh all of these are opportunities. Um uh you get the chance, you know, ii become very interested in ventilation and its history of it. Um And you know, these are the kind of things that um that we become good at and understand a lot about. And you know, interestingly, Copenhagen 1952 the polio epidemic was said to be the advent of modern intensive care medicine where positive pressure ventilation came into its own light outside theater cases. This young girl was dying of polio and was dying in her own secretions if you like, because of the negative pressure ventilator of which there are very few uh were not working in expanding her lungs. And so, um Bjork Ibsen who was a, a Danish anesthetist was persuaded to do a tracheostomy in theater. He'd been and others had been doing tracheostomies as a result of tetanus cases which were rife at the time as well. But um those in with polio were not getting that. And then he demonstrate uh that he was able to keep her alive uh using this um uh what's called water circuit. So this big um silver cylinder was contained soda lime, so it could absorb the expired CO2. And therefore, uh air and oxygen delivery was uh was provided and CO2 clearance uh was allowed and um teams of um of helpers and volunteers did round clock shifts to ensure ventilation um occurred bag valve mask ventilation. And who were those teams? They were the medical and dental students of Co University over the course of a month. And you can see mortality fell from um just over just under 8000 cases. So 80% mortality fell to about 20% mortality just in a month as a result of this. And then as a result of that, um the um the bigger companies started to mass produce um the positive pressure ventilators that are now commonplace in, in the ICU. Um So this was uh the pathway, it may have changed a little bit now. But you can see that uh you acute care um uh common stem pathway or anesthetics or core medical training, uh You would then do some form of higher degree in MCP or uh M CE M for em medicine F RCA primary. You then apply and hopefully get on to the specialty training program um and do final exams. But there's, that's the single, so single. Um CT took seven years uh and dual CT s uh would take about 8.5 years um until you get your um uh certificate of completion, a certificate of completion of training. And A R DS is something that uh you know, we, we've been very involved with as a, as a uh an exemplar of acute respiratory failure and co one of um uh the centers in the UK that um provides ECMO and was um uh life saving for so many um during the COVID pandemic where you can effectively stop the clock and keep people, you know, who would have died. Uh either as a result of the um the injury to the lungs itself or as a result of the uh the injurious ventilation that is necessary to keep oxygen and CO2 clearance going. Um You can effectively take that out of the equation by this extracorporeal circuit which effectively does the uh the oxygenation and the CO2 clearance while the lungs can rest and recover and, you know, they're external. Uh uh we have retrieval teams that go around uh the regions to uh pick up patients from um uh from the different hospitals where the referrals come through a central referral pathway. So that's just a, that's just a, an insight into some of the um uh critical care aspects of, of what we do. Um I haven't shown the pulmonary aspects but um as I said, there are many and it's very varied. Thank you for that. That was really interesting. We do have a couple of more questions in the chat. Um Sure. So, um, so Michelle, uh how does a typical day in your life look? Well, I guess I've just shown you that uh Michelle. So that's pretty uh pretty much what it is. But um ii tend to and, and people will have different uh job plans, um which is effectively your weekly um rota. And uh I have um roughly every 86 to 6 to 8 weeks. Uh I have a week of ICU uh um and uh either at the Brompton or at uh Chelsea my two NHS hospitals and then uh I in the non ICU weeks, I will have my uh clinics. Um So as I said, sleep ventilation clinic, um my uh general medical clinic which has a sort of a, an interstitial lung disease interest. Um And um and then I'll fit in time for my academic day, which is Tuesdays where um I work with my um uh BSC student colleagues and fellows, etcetera. So it tends to vary. Um um And I also fit in some private medicine as well outside those uh uh you know, that those fields. So it's, it's crammed, it's crowded. Um But uh you just need to be good at organizing things and having a good, good diary schedule. Um So it's very varied and I, and I love that. I think others might find that a little too um disruptive. Um But, you know, you can mold what you do as you go along. Um How do you manage to balance both clinical medicine and research? Um It's always, it's always a challenge but, you know, when you're doing things that you enjoy, it motivates you to do it. And I think the crucial thing is you mustn't spread self in and it can happen at times where you think you're trying to please everyone. And um but actually then what you're doing is you're not, you're not providing the level of attention and detail and quality if you like um that you should be and I think that's important to have to have that um perspective as well. But um it, you do manage it and you will all have a sense of uh what you want to do and look these things develop over time and um you'll be slightly pulled by the um circumstances in which you work, but that shouldn't um uh suppress you or subdue what your interests are. And you just have to be smart enough to ask people who are likely to be able to help you in, um, in, in what you want to do. And you know, that's one of the, the great pleasures is to uh to, to get calls or emails or conversations with people who have been your med students who then, you know, are your trainees or they ask you for assistance or references or whatever it is and then, you know, a lot of them and, and I can speak from my own experience, have become consultant colleagues of mine, you know, over the years as well. So that's, that's great. Um I II love that through my um you know, um college societies as well and keeping, keeping links with the people through that. Um So, yeah, so it's, it's around balance, it's around interest and what motivates you. Um And it's around results and, you know, achieving things, success, shared success with people. Um Sneezer was asking um uh what a career highlights, uh regrets things that you would have done differently in hindsight. Um uh OK, so career highlights, um uh let's see, you know, that it sounds a bit cheesy, but I really enjoy what I do. And so that, you know, that for me is, is a highlight. Um you know, you got you um if you get to do that and, you know, there are days that are rubbish days, um, but there are days that, um, make up for that and often that's just, um, having an opportunity to speak to a patient or someone, um, who, you know, you've been seeing for many years or you say something that is, um, uh that, that is comforting to, to, to a patient or their relative. You know, those are, those are real highlights on a daily basis. Um uh Of course, it's wonderful. Um You know, if you get uh positive feedback from um your uh trainees, your colleagues, um it's, it's also great if you get a thank you, you know, it makes it work uh worthwhile. Um uh And uh from an academic perspective, if you, you know, if you do something that people like in terms of delivery of shared learning or if you um you know, publish things or uh get a grant that allows you to support others, those are, those are, those are great highlights. I won't, um you know, I won't deny that getting my uh professorship was a great highlight for me that it was just a personal um vindication of effort that I had put in and recognition that that that had happened and, you know, allowing me to um to do the things that I enjoy, which is respiratory and critical care medicine, teaching and research. Um And more recently, the actually the book that I edited is um uh that's been a highlight because that's been going on for years and years. And um it, when it started, the project started, as is often the case with these things you, um you think, right, this will get done in a couple of years or so. Um And um it took seven years and one of the editors dropped out. I ended up having to sort of keep the thing afloat and then getting another editor on board. Um And uh then we went through COVID, people had to rewrite their chapters. Um But I set myself that task that was gonna, that I was going to complete it. And um, and I'll just share, I'll just share that with you. Um And um and we did, it was literally, I put a placeholder in every week on a Friday between my two clinics where we would meet up with the editors and um and then contact the, um you know, 200 or so authors individually. Uh It was 66 chapters. We had to get them to write it, get them to write it on time or remind them including chapters we were writing ourselves. And then, um and then we had to do three edits uh as well. So I would edit, then my colleague, um Andrew would edit, he's at Cambridge. And then, and then uh Paulo who's passed away uh would uh would give some insight uh real, real insight into, um, you know, in, in, into publishing work, which I didn't really have a, or at least um uh uh editing a big book, you know, uh 350 or so pages. But that's been a, uh you know, to see that over the line was a very pleasing um uh thing for me as well. Oh, it's lovely. Thank you very much for sharing that. Um Any other questions we've got and you can always um you know, if there are any, any queries or anything you have, but you can, you know, you're more than welcome to email me. Um So, uh my, my email is um Sua dot Singh at ic.ac.uk. Um But um the, the good thing is that there's, there's a huge amount of resource in terms of um this and you can always do taste of weeks as well and that's a good, good opportunity and provide you with some insight into these different aspects of um of clinical medicine and research, et cetera. Definitely um any other questions um I will be sending the feedback form in the chat as well. Um Well, if not, you know, it's, it's been great to um you know, to, to share thoughts with you. Um I'd um yeah, as I said, you know, hopefully it's giving you a little bit of a um an insight into a personal journey. Um uh and uh you know, the, the opportunities that uh that, that you can that you can take, you know, by doing uh pulmonary and critical care medicine. It was a wonderful talk. Thank you so much for your time. Pleasure. All right. Um Wish you all a good evening and um uh uh and, and, and the best of luck with uh with your future uh be a uh talks. Thank you. Thank you very much. All right, take care. Bye bye.